[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2425 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2425

 To amend title XVIII of the Social Security Act to improve access to 
  diabetes self-management training by designating certain certified 
 diabetes educators as certified providers for purposes of outpatient 
diabetes self-management training services under part B of the Medicare 
                                Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 14, 2009

 Ms. DeGette (for herself, Mr. Castle, Mr. Kirk, Mr. Becerra, and Mr. 
    Space) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to improve access to 
  diabetes self-management training by designating certain certified 
 diabetes educators as certified providers for purposes of outpatient 
diabetes self-management training services under part B of the Medicare 
                                Program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Diabetes Self-Management 
Training Act of 2009''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Diabetes is widely recognized as one of the top public 
        health threats currently facing the United States. 
        Approximately 24,000,000 people in the United States are 
        currently living with diabetes, and another 57,000,000 people 
        in the United States have pre-diabetes, dramatically raising 
        their risk of developing diabetes, heart disease, and stroke. 
        Three million individuals with diagnosed diabetes receive no 
        treatment for the disease, and only about 56 percent of those 
        newly diagnosed with diabetes receive the type of diet and 
        exercise counseling that are vital components of a diabetes 
        self management training (DSMT) regimen. The number of 
        Americans living with diabetes increased 50 percent between 
        1997-2004, and the Centers for Disease Control projects that 
        the prevalence of diagnosed diabetes in the U.S. will increase 
        165 percent by 2050.
            (2) Diabetes costs the United States over $174 billion 
        annually, with $116 billion attributed to direct medical costs 
        associated with diabetes care, and $58 billion attributed to 
        indirect costs associated with lost productivity. Eighteen 
        percent of all Medicare beneficiaries have diabetes, accounting 
        for 32 percent of Medicare spending.
            (3) Diabetes self-management training, also called diabetes 
        education, provides critical knowledge and skills training to 
        patients with diabetes, helping them identify barriers, 
        facilitate problem solving, and develop coping skills to 
        effectively manage their diabetes. A certified diabetes 
        educator is a health care professional, often a nurse, 
        dietitian, or pharmacist, who specializes in helping people 
        with diabetes develop the self-management skills needed to stay 
        healthy and avoid costly acute complications and emergency 
        care, as well as debilitating secondary conditions caused by 
        diabetes.
            (4) Diabetes self-management training has been proven 
        effective in helping to reduce the risks and complications of 
        diabetes. In 2002, the Diabetes Prevention Program study 
        conducted by the National Institutes of Health and the Centers 
        for Disease Control and Prevention found that participants (all 
        of whom were at increased risk of developing type 2 diabetes) 
        who made lifestyle changes reduced their risk of getting type 2 
        diabetes by 58 percent. Lifestyle intervention worked in all of 
        the groups but it worked particularly well in people aged 60 
        and older, reducing the development of diabetes by 71 percent. 
        Similarly, studies have found that patients under the care of a 
        certified diabetes educator are better able to control their 
        diabetes and report improvement in their health status.
            (5) Lifestyle changes, such as those taught by certified 
        diabetes educators, directly contribute to better glycemic 
        control and reduced complications from diabetes. Evidence shows 
        that the potential for prevention of the most serious medical 
        complications caused by diabetes to be as high as 90 percent 
        (blindness), 85 percent (amputations), and 50 percent (heart 
        disease and stroke) with proper medical treatment and active 
        self-management.
            (6) There are currently more than 20,000 diabetes educators 
        in the United States, most of whom are certified diabetes 
        educators credentialed by the National Certification Board for 
        Diabetes Educators. Eligibility for certification as a diabetes 
        educator by the National Certification Board for Diabetes 
        Educators requires prerequisite qualifying professional 
        credentials in specific health care professions and 
        professional practice experience that includes a minimum number 
        of hours and years of experience in diabetes self-management 
        training. Diabetes educators certified by the National 
        Certification Board for Diabetes Educators must also pass a 
        rigorous national examination and periodically renew their 
        credentials. Diabetes educators certified by the National 
        Certification Board for Diabetes Educators, and licensed by a 
        State as a health professional, are uniquely qualified to 
        provide diabetes self-management training under the Medicare 
        program.
            (7) Enhancing access to diabetes self-management training 
        programs that are taught by Certified Diabetes Educators is an 
        important public policy goal that can help improve health 
        outcomes, ensure quality, and reduce escalating diabetes-
        related health costs.

SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDUCATORS AS CERTIFIED 
              PROVIDERS FOR PURPOSES OF MEDICARE DIABETES OUTPATIENT 
              SELF-MANAGEMENT TRAINING SERVICES.

    (a) In General.--Section 1861(qq) of the Social Security Act (42 
U.S.C. 1395x(qq)) is amended--
            (1) in paragraph (1), by inserting ``or by a certified 
        diabetes educator (as defined in paragraph (3))'' after 
        ``paragraph (2)(B)''; and
            (2) by adding at the end the following new paragraphs:
            ``(3) For purposes of paragraph (1), the term `certified 
        diabetes educator' means an individual who--
                    ``(A) is licensed or registered by the State in 
                which the services are performed as a health care 
                professional;
                    ``(B) specializes in teaching individuals with 
                diabetes to develop the necessary skills and knowledge 
                to manage the individual's diabetic condition; and
                    ``(C) is certified as a diabetes educator by a 
                recognized certifying body (as defined in paragraph 
                (4)).
            ``(4)(A) For purposes of paragraph (3)(B), the term 
        `recognized certifying body' means--
                            ``(i) the National Certification Board for 
                        Diabetes Educators, or
                            ``(ii) a certifying body for diabetes 
                        educators, which is recognized by the Secretary 
                        as authorized to grant certification of 
                        diabetes educators for purposes of this 
                        subsection pursuant to standards established by 
                        the Secretary,
                if the Secretary determines such Board or body, 
                respectively, meets the requirement of subparagraph 
                (B).
                    ``(B) The National Certification Board for Diabetes 
                Educators or a certifying body for diabetes educators 
                meets the requirement of this subparagraph, with 
                respect to the certification of an individual, if the 
                Board or body, respectively, is incorporated and 
                registered to do business in the United States and 
                requires as a condition of such certification each of 
                the following:
                            ``(i) The individual has a qualifying 
                        credential in a specified health care 
                        profession.
                            ``(ii) The individual has professional 
                        practice experience in diabetes self-management 
                        training that includes a minimum number of 
                        hours and years of experience in such training.
                            ``(iii) The individual has successfully 
                        completed a national certification examination 
                        offered by such entity.
                            ``(iv) The individual periodically renews 
                        certification status following initial 
                        certification.''.
    (b) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study to identify the barriers that exist for 
        Medicare beneficiaries with diabetes in accessing diabetes 
        self-management training services under the Medicare program, 
        including economic and geographic barriers and availability of 
        appropriate referrals and access to adequate and qualified 
        providers.
            (2) Report.--Not later than 1 year after the date of the 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to Congress a report on the study conducted 
        under paragraph (1).
    (c) AHRQ Development of Recommendations for Outreach Methods and 
Report.--
            (1) Development of recommendations.--The Director of the 
        Agency for Healthcare Research and Quality shall, through use 
        of a workshop and other appropriate means, develop a series of 
        recommendations on effective outreach methods to educate 
        primary care physicians and the public about the benefits of 
        diabetes self-management training in order to promote better 
        health outcomes for patients with diabetes.
            (2) Report.--Not later than 1 year after the date of the 
        enactment of this Act, the Director of the Agency for 
        Healthcare Research and Quality shall submit to Congress a 
        report on the recommendations developed under paragraph (1).
    (d) Effective Date.--The amendments made by subsection (a) shall 
apply to diabetes outpatient self-management training services 
furnished on or after the first day of the first calendar year that is 
at least 6 months after the date of the enactment of this Act.
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