[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4124 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 4124

 To amend the Public Health Service Act with respect to the prevention 
                  of diabetes, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 19, 2009

 Mrs. Davis of California (for herself, Ms. Richardson, Mr. Loebsack, 
and Ms. Bordallo) introduced the following bill; which was referred to 
                  the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act with respect to the prevention 
                  of diabetes, and for other purposes.

    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 ``Diabetes Prevention Act of 2009''.

SEC. 2. FINDINGS.

    The Congress makes the following findings:
            (1) According to the Centers for Disease Control and 
        Prevention (CDC), the prevalence of diabetes in the United 
        States has more than doubled in the past quarter-century.
            (2) The CDC reports that there are now more than 23,600,000 
        people in the United States living with diabetes and another 
        57,000,000 individuals with ``pre-diabetes'' in the United 
        States, which means that they have higher than normal blood 
        glucose levels or are at increased risk of developing diabetes 
        based on multiple risk factors.
            (3) In 2002, the landmark Diabetes Prevention Program (DPP) 
        study found that lifestyle changes, such as diet and exercise, 
        can prevent or delay the onset of type 2 diabetes, and that 
        participants who made such lifestyle changes reduced their risk 
        of getting type 2 diabetes by 58 percent with some returning to 
        normal blood glucose levels.
            (4) The New York Times has reported that lifestyle-based 
        interventions to control diabetes have resulted in positive 
        outcomes for patients, yet despite these successes, such 
        interventions were often unsustainable. While insurance 
        companies cover the treatments of complications of unchecked 
        diabetes, they tend not to cover the cheaper interventions to 
        prevent such complications.
            (5) Emerging research and demonstrations projects funded by 
        the National Institutes of Health and the CDC in partnership 
        with Indiana University and the YMCA show that a carefully 
        designed group lifestyle intervention can be delivered for less 
        than $250 per person per year in community settings and can 
        achieve similar weight loss results to the DPP for adults with 
        pre-diabetes.
            (6) Diabetes carries staggering costs. In 2007, the total 
        amount of the direct and indirect costs of diabetes was 
        estimated at $174,000,000,000 according to the American 
        Diabetes Association.
            (7) The Urban Institute reported that if the Nation makes a 
        substantial investment in a national program that supports 
        group-based structured lifestyle intervention programs for 
        individuals at-risk of developing type 2 diabetes offered by 
        trained non-clinicians in community settings, the Nation could 
        save $191,000,000,000 over 10 years and achieve a 50 percent 
        reduction in diabetes cases among participants.
            (8) There is a need to increase the availability of 
        effective community-based lifestyle programs for diabetes 
        prevention and offer incentive payments to health care 
        providers who refer at-risk patients for enrollment in such 
        programs to prevent diabetes, reduce complications, and lower 
        the costs associated with diabetes treatment in the United 
        States, and the Federal Government should encourage efforts to 
        replicate the results of the Diabetes Prevention Program on a 
        wider scale.

SEC. 3. NATIONAL DIABETES PREVENTION PROGRAM.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by inserting after section 317T the following:

``SEC. 317U. NATIONAL DIABETES PREVENTION PROGRAM.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall establish a 
national diabetes prevention program targeted at persons at high risk 
for diabetes of all ages in order to eliminate the preventable burden 
of diabetes.
    ``(b) Program.--The program under subsection (a) shall include the 
following:
            ``(1) Grants for community-based diabetes prevention 
        program model sites for persons at high risk for diabetes.--The 
        Secretary may award grants to recognized eligible entities--
                    ``(A) to support community-based diabetes 
                prevention program model sites that work with the 
                health care delivery system--
                            ``(i) to identify persons at high risk for 
                        diabetes; and
                            ``(ii) to refer such persons to, or provide 
                        such persons with, cost-effective group-based 
                        lifestyle intervention programs; and
                    ``(B) to evaluate--
                            ``(i) methods for ensuring the scalability 
                        of recognized community-based diabetes 
                        prevention program sites nationally;
                            ``(ii) the health and economic benefits of 
                        a national diabetes prevention program for 
                        persons at high risk for diabetes in certain 
                        age groups, including the pre-Medicare 
                        population;
                            ``(iii) emerging approaches to identify and 
                        engage persons at high risk for diabetes in 
                        health care and community-based programs;
                            ``(iv) novel strategies for linking 
                        community-based program delivery with existing 
                        clinical services; and
                            ``(v) the costs and cost effectiveness of 
                        clinic-community linkages.
            ``(2) Recognition program.--The Secretary shall develop and 
        implement a program under which the Secretary recognizes, and 
        re-recognizes on an annual basis, eligible entities that 
        deliver community-based diabetes prevention programs. To be 
        recognized under this paragraph, an eligible entity shall--
                    ``(A) describe its system for obtaining referral 
                from health care professionals for persons at high risk 
                for diabetes;
                    ``(B) provide proof that the entity's staff have 
                been trained as diabetes prevention program lifestyle 
                interventionists and the entity has a system in place 
                to ensure that staff receive timely training updates;
                    ``(C) agree to maintain a community board (for 
                purposes of advising the entity's community-based 
                diabetes prevention program) whose membership 
                includes--
                            ``(i) a person at high risk for diabetes 
                        who has completed a lifestyle intervention;
                            ``(ii) a health care professional who 
                        refers persons at high risk for diabetes to 
                        lifestyle intervention programs;
                            ``(iii) community leaders;
                            ``(iv) representatives of the health 
                        insurance industry; and
                            ``(v) representatives of employers, 
                        businesses, and nonprofit organizations that 
                        are committed to offering healthy food and 
                        physical activity opportunities for residents;
                    ``(D) agree to provide data to the Secretary for 
                outcome evaluation monitoring purposes and quality 
                improvement, including data regarding the number of 
                persons served, participant attendance, completion 
                rates, weight loss obtained, participant satisfaction, 
                and referring clinician satisfaction;
                    ``(E) develop a plan for communications between 
                referring clinicians and community-based diabetes 
                prevention program model sites;
                    ``(F) agree to make available to the Secretary 
                copies of materials used in the entity's community-
                based diabetes prevention program; and
                    ``(G) provide evidence to the Secretary of quality 
                checks on trainers.
            ``(3) Training and outreach.--In partnership with State 
        diabetes prevention and control programs, academic 
        institutions, and a national network of community-based 
        nonprofit organizations focused on health and well-being, the 
        Secretary shall develop and implement, directly or through 
        grants to eligible entities--
                    ``(A) a curriculum development and training program 
                for diabetes prevention master and lifestyle 
                intervention instructors to ensure consistency in--
                            ``(i) the principles of type 2 diabetes 
                        prevention programming throughout the United 
                        States; and
                            ``(ii) the collection of outcomes data for 
                        quality assurance;
                    ``(B) community outreach programs to identify 
                community and provider groups to participate in the 
                national diabetes prevention program and coordinate 
                quality assurance programs at the local level in 
                partnership with community-based organizations; and
                    ``(C) a national partner outreach program to 
                identify and work with national partners--
                            ``(i) to identify workers in the community 
                        to complete training under subparagraph (A); 
                        and
                            ``(ii) to facilitate the recognition of 
                        eligible entities under paragraph (2).
            ``(4) Evaluation, monitoring, and technical assistance.--
        The Secretary shall provide quality assurance for each 
        community-based diabetes prevention program model site funded 
        under paragraph (1) and, as necessary and feasible, for other 
        recognized community-based diabetes prevention programs through 
        evaluation, monitoring, and technical assistance, including 
        by--
                    ``(A) reviewing applications for recognition under 
                paragraph (2);
                    ``(B) evaluating and monitoring program data 
                including providing standardized feedback to sites for 
                quality improvement;
                    ``(C) making de-identified data available to the 
                public to ensure transparency of the recognition 
                program under paragraph (2);
                    ``(D) conducting site visits and periodic audits;
                    ``(E) providing technical assistance and a process 
                for improving performance in sites not meeting 
                standards for recognition under paragraph (2); and
                    ``(F) establishing a public registry of recognized 
                eligible entities.
            ``(5) Applied research programs.--The Secretary shall award 
        grants to eligible entities to conduct diabetes prevention 
        research that--
                    ``(A) advances the scalability of recognized 
                community-based diabetes prevention program sites 
                nationally;
                    ``(B) examines model benefit and payment designs; 
                and
                    ``(C) tests communications strategies to engage 
                providers and targeted at-risk populations.
            ``(6) Studies for diabetes prevention and management.--To 
        build on the findings of the national diabetes prevention 
        program under this section, the Secretary may conduct or 
        support studies to manage, reduce, and prevent type 2 diabetes 
        in at-risk populations, including consideration of factors such 
        as nutrition, exercise education, and basic physical 
        maintenance of healthy levels of cholesterol, body mass index, 
        hemoglobin A1C, and blood pressure rates.
    ``(c) Report to Congress.--Not later than the end of fiscal year 
2011, and every 2 years thereafter, the Secretary shall submit a report 
to the Congress on the implementation of this section, including the 
progress achieved in eliminating the preventable burden of diabetes.
    ``(d) Definitions.--In this section:
            ``(1) The term `eligible entity' means--
                    ``(A) a State or local health department;
                    ``(B) a national network of community-based 
                organizations described in section 501(c)(3) of the 
                Internal Revenue Code of 1986 that is focused on health 
                and well-being;
                    ``(C) an academic institution;
                    ``(D) an Indian tribe or tribal organization (as 
                defined in section 4 of the Indian Self-Determination 
                and Education Assistance Act); or
                    ``(E) any other entity determined by the Secretary 
                to be an eligible entity for purposes of this section.
            ``(2) The term `person at high risk for diabetes' means an 
        individual who has higher than normal blood glucose levels or 
        is at an increased risk for developing diabetes based on 
        multiple risk factors.
            ``(3) The term `recognized' means recognized under 
        subsection (b)(2).
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $80,000,000 for fiscal year 
2011, and such sums as may be necessary for each subsequent fiscal 
year.''.
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