II 112th CONGRESS 1st Session S. 1468 IN THE SENATE OF THE UNITED STATES August 2, 2011 Mrs. Shaheen (for herself and Mr. Tester) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to improve access to diabetes self-management training by authorizing certified diabetes educators to provide diabetes self-management training services, including as part of telehealth services, under part B of the Medicare program.

1.

Short title

This Act may be cited as the Medicare Diabetes Self-Management Training Act of 2011.

2.

Findings

Congress makes the following findings: (1)Diabetes self-management training, also called diabetes education, provides critical knowledge and skills training to patients with diabetes, helping them manage medications, address nutritional issues, facilitate diabetes related problem solving, and make other critical lifestyle changes to effectively manage their diabetes. (2)A certified diabetes educator is a State licensed or registered health care professional 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. (3)Diabetes self-management training has been proven effective in helping to reduce the risks and complications of diabetes and is a vital component of an overall diabetes treatment regimen. Patients under the care of a certified diabetes educator are better able to control their diabetes and improve their health status. (4)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. (5)Despite its effectiveness in reducing diabetes related complications and associated costs, diabetes self-management training has been recognized by policymakers as an underutilized Medicare benefit. 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.

3.

Recognition of certified diabetes educators as authorized providers 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 striking by a certified provider (as described in paragraph (2)(A)) in an outpatient setting and inserting in an outpatient setting by a certified diabetes educator (as defined in paragraph (3)) or by a certified provider (as described in paragraph (2)(A)); 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)For purposes of paragraph (3)(C), the term recognized certifying body means 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. . (b)

Treatment as a practitioner, including for telehealth services

Section 1842(b)(18)(C) of the such Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clause: (vii)A certified diabetes educator (as defined in section 1861(qq)(3)). . (c)

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). (d)

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). (e)

Effective date

The amendments made by this section shall apply to items and services furnished on or after January 1, 2013.