[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 945 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                 S. 945

 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.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 14, 2013

Mrs. Shaheen (for herself, Ms. Collins, Mr. Begich, Mrs. Hagan, and Mr. 
   Franken) 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.

    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 ``Access to Quality Diabetes Education 
Act of 2013''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The Centers for Disease Control and Prevention 
        (hereinafter ``CDC'') report that nearly 26,000,000 Americans 
        have diabetes, in addition to an estimated 79,000,000 Americans 
        who have prediabetes, an increase of 24,000,000 Americans with 
        either diabetes or prediabetes since 2008. People with 
        prediabetes are at increased risk of developing Type 2 diabetes 
        or cardiovascular disease.
            (2) Diabetes impacts 8.3 percent of all Americans and 11.3 
        percent of American adults. The CDC estimates that as many as 1 
        in 3 Americans will have diabetes by 2050 if current trends 
        continue.
            (3) According to the American Diabetes Association, the 
        total costs of diagnosed diabetes have risen to $245 billion in 
        2012 from $174 billion in 2007, when the cost was last examined 
        by the CDC. This figure represents a 41 percent increase over a 
        five-year period.
            (4) One in 3 Medicare dollars is currently spent on people 
        with diabetes.
            (5) There were 11.3 million diabetes related emergency room 
        visits in 2008, compared with 9.5 million in 2000, an increase 
        of 11 percent.
            (6) According to the CDC, health care providers are finding 
        statistically significant increases in the prevalence of Type 2 
        diabetes in children and adolescents.
            (7) Diabetes self-management training (hereinafter 
        ``DSMT''), 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. Evidence shows that individuals participating in DSMT 
        programs are able to progress along the continuum necessary to 
        make sustained behavioral changes in order to manage their 
        diabetes.
            (8) 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.
            (9) 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 who have received training from a 
        certified diabetes educator are better able to implement the 
        treatment plan received from a physician skilled in diabetes 
        treatment.
            (10) 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.
            (11) In recognition of the important role of DSMT programs, 
        the CDC in 2012 awarded funding to expand the National Diabetes 
        Prevention Program to help prevent the onset of Type 2 diabetes 
        for individuals at high risk.
            (12) The net savings to the Medicare program of ensuring 
        that beneficiaries have access to quality DSMT is estimated to 
        be $2,000,000,000 over 10 years.
            (13) Despite its effectiveness in reducing diabetes-related 
        complications and associated costs, diabetes self-management 
        training has been recognized by the Centers for Medicare & 
        Medicaid Services as an underutilized Medicare benefit, even 
        after more than a decade of coverage.
            (14) Enhancing access to diabetes self-management training 
        programs that are certified as necessary by the patient's 
        treating physician and 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 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--
            ``(A) who is licensed or registered by the State in which 
        the services are performed as a certified diabetes educator; or
            ``(B) who--
                    ``(i) is licensed or registered by the State in 
                which the services are performed as a health care 
                professional;
                    ``(ii) specializes in teaching individuals with 
                diabetes to develop the necessary skills and knowledge 
                to manage the individual's diabetic condition; and
                    ``(iii) is certified as a diabetes educator by a 
                recognized certifying body (as defined in paragraph 
                (4)).
    ``(4) For purposes of paragraph (3)(B)(iii), 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 
        physicians and other health care providers as well as 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 after the end of the 12-month 
period beginning on the date of the enactment of this Act.
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