[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5768 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5768

 To amend title XVIII of the Social Security Act to improve access to 
 diabetes outpatient self-management training services, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 10, 2018

 Mr. Reed (for himself and Ms. DeGette) 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 outpatient self-management training services, 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 ``Expanding Access to Diabetes Self-
Management Training Act of 2018'' or the ``Expanding Access to DSMT Act 
of 2018''.

SEC. 2. IMPROVING ACCESS TO 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)--
                    (A) by striking ``the Secretary determines 
                appropriate'' and inserting ``specified in paragraph 
                (3)'';
                    (B) by inserting ``or qualified nonphysician 
                practitioner'' after ``only if the physician''; and
                    (C) by inserting ``(or other physician or qualified 
                nonphysician practitioner furnishing items or services 
                to such individual, in coordination with the physician 
                or qualified nonphysician practitioner managing such 
                individual's diabetic condition)'' after ``managing the 
                individual's diabetic condition'';
            (2) in paragraph (2)(B), by striking ``paragraph'' and 
        inserting ``subparagraph''; and
            (3) by adding at the end the following new paragraphs:
    ``(3) For purposes of paragraph (1), the times specified in this 
paragraph are the following:
            ``(A) An initial 10 hours of educational and training 
        services described in paragraph (1), to remain available until 
        used.
            ``(B) Six additional hours (or a greater number of hours if 
        determined appropriate by the Secretary) of such services 
        during the year in which the individual exhausts the initial 
        hours described in subparagraph (A), provided that the 
        physician or qualified nonphysician practitioner who is 
        managing the individual's diabetic condition (or other 
        physician or qualified nonphysician practitioner furnishing 
        items or services to such individual, in coordination with the 
        physician or qualified nonphysician practitioner managing such 
        individual's diabetic condition) certifies the medical 
        necessity of such additional hours.
            ``(C) Six additional hours (or a greater number of hours if 
        determined appropriate by the Secretary) of such services per 
        year for each year beginning after the year in which the 
        individual exhausts the initial hours described in subparagraph 
        (A), provided that the physician or qualified nonphysician 
        practitioner who is managing the individual's diabetic 
        condition (or other physician or qualified nonphysician 
        practitioner furnishing items or services to such individual, 
        in coordination with the physician or qualified nonphysician 
        practitioner managing such individual's diabetic condition) 
        certifies the medical necessity of such additional hours.
            ``(D) For a year in which the individual has received 
        additional hours described in subparagraph (B) or (C) and 
        exhausted such hours, an additional number of hours determined 
        appropriate by the physician or qualified nonphysician 
        practitioner who is managing the individual's diabetic 
        condition (or other physician or qualified nonphysician 
        practitioner furnishing items or services to such individual, 
        in coordination with the physician or qualified nonphysician 
        practitioner managing such individual's diabetic condition), 
        provided that the physician or qualified nonphysician 
        practitioner who is managing the individual's diabetic 
        condition (or other physician or qualified nonphysician 
        practitioner furnishing items or services to such individual, 
        in coordination with the physician or qualified nonphysician 
        practitioner managing such individual's diabetic condition) 
        certifies that--
                    ``(i) there has been a change in the individual's 
                diagnosis, medical condition, or treatment regimen;
                    ``(ii) the individual is not meeting appropriate 
                clinical outcomes (as determined by such physician or 
                qualified nonphysician practitioner) for such 
                condition; or
                    ``(iii) the individual meets other criteria that 
                necessitates such additional number of hours, as 
                determined by the Secretary.
    ``(4) For purposes of this section, the term `qualified 
nonphysician practitioner' means a physician assistant, nurse 
practitioner, or clinical nurse specialist (as defined in section 
1861(aa)(5)).''.
    (b) Medical Nutrition Therapy Services.--Section 1861(s)(2)(V) of 
such Act (42 U.S.C. 1395x(s)(2)(V)) is amended--
            (1) by striking clause (i);
            (2) by redesignating clauses (ii) and (iii) as clauses (i) 
        and (ii), respectively; and
            (3) in clause (ii), as so redesignated, by striking ``after 
        consideration of'' and inserting ``consistent with''.
    (c) Cost-sharing.--Section 1833 of such Act (42 U.S.C. 1395l) is 
amended--
            (1) in subsection (a)(1)--
                    (A) by striking ``and (BB)'' and inserting 
                ``(BB)''; and
                    (B) by striking the semicolon at the end and 
                inserting ``, and (CC) with respect to diabetes 
                outpatient self-management training services (as 
                defined in section 1861(qq)), the amount paid shall be 
                100 percent of the lesser of the actual charge for the 
                services or the amount determined under the fee 
                schedule that applies to such services under this 
                part;''; and
            (2) in subsection (b)--
                    (A) by striking ``and (10)'' and inserting 
                ``(10)''; and
                    (B) by striking ``1861(hhh)(1)).'' and inserting 
                ``1861(hhh)(1)), and (11) such deductible shall not 
                apply with respect to diabetes outpatient self-
                management training services (as defined in section 
                1861(qq)).''
    (d) Revision of Manual.--Not later than 180 days after the date of 
the enactment of this Act, the Secretary of Health and Human Services 
shall revise the Medicare Benefit Policy Manual to ensure that diabetes 
outpatient self-management training services (as defined in section 
1861(qq) of the Social Security Act (42 U.S.C. 1395x(qq)), as amended 
by subsection (a)) may be furnished by an entity that is a hospital 
outpatient department at alternate, nonhospital sites (including 
community-based locations).
    (e) Application.--The amendments made by this section shall apply 
with respect to items and services furnished on or after January 1, 
2019.

SEC. 3. VIRTUAL DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES 
              DEMONSTRATION PROGRAM.

    (a) In General.--Beginning not later than January 1, 2019, the 
Secretary of Health and Human Services (in this section referred to as 
the ``Secretary'') shall select an appropriate number of applicable 
beneficiaries to participate in a 2-year demonstration program to test 
the impact of furnishing diabetes outpatient self-management training 
services through a qualified online platform with respect to cost and 
clinical outcomes for such applicable beneficiaries. Under such 
program, diabetes outpatient self-management training services 
furnished through a qualified online platform to an applicable 
beneficiary shall be covered under title XVIII of the Social Security 
Act, and payment for such services shall be made in the same manner as 
payment is made under such title for such services furnished in an 
outpatient setting.
    (b) Definitions.--In this section:
            (1) Applicable beneficiary.--The term ``applicable 
        beneficiary'' means an individual--
                    (A) who is enrolled under part B of title XVIII of 
                the Social Security Act;
                    (B) who has a diagnosis of diabetes; and
                    (C) who agrees to take part in the demonstration 
                program described in subsection (a).
            (2) Qualified online platform.--The term ``qualified online 
        platform'' means an online-based platform--
                    (A) designed to furnish educational and training 
                services to an individual with diabetes to ensure 
                therapy compliance with respect to the individual's 
                diabetic condition or to provide the individual with 
                necessary skills and knowledge (including skills 
                related to the self-administration of injectable drugs) 
                to participate in the individual's management of such 
                condition; and
                    (B) that meets the National Standards for Diabetes 
                Self-Management Education and Support, as jointly 
                published by the American Association of Diabetes 
                Educators and the American Diabetes Association.
            (3) Diabetes self-management training services.--The term 
        ``diabetes outpatient self-management training services'' has 
        the meaning given such term in section 1861(qq) of the Social 
        Security Act (42 U.S.C. 1395x(qq)) except that the requirement 
        in paragraph (1) of such section with respect to such services 
        being furnished in an outpatient setting shall not apply.
    (c) Evaluation.--The Secretary shall evaluate the demonstration 
program described in subsection (a) based on the following criteria:
            (1) The improvement, if any, in health outcomes with 
        respect to the diabetic conditions of applicable beneficiaries 
        participating in such program as evidenced by--
                    (A) any improvement attributable to such program in 
                the knowledge of such beneficiaries with respect to 
                such conditions;
                    (B) any behavioral changes attributable to such 
                program;
                    (C) any clinical outcome improvements attributable 
                to such program;
                    (D) any quality of life improvements attributable 
                to such program; and
                    (E) the overall satisfaction of such beneficiaries 
                with such program.
            (2) Reductions, if any, in expenditures under title XVIII 
        of the Social Security Act attributable to such program.
            (3) Other criteria determined appropriate by the Secretary.
    (d) Report.--Not later than 18 months after the date of the 
completion of the demonstration program described in subsection (a), 
the Secretary shall submit to Congress a report containing--
            (1) the results of the evaluation described in subsection 
        (c);
            (2) an analysis of the demographic characteristics of 
        applicable beneficiaries who participated in such program; and
            (3) a recommendation on whether such program should be 
        continued or expanded.
    (e) Waiver Authority.--The Secretary may waive such requirements of 
titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq., 
1395 et seq.) as may be necessary to carry out the provisions of this 
section.
    (f) Authority To Expand Demonstration Program.--Notwithstanding 
subsection (a), taking into account the evaluation described in 
subsection (c), the Secretary may, through rulemaking, expand the 
duration and the scope of the demonstration program described in 
subsection (a), to the extent determined appropriate by the Secretary, 
if--
            (1) the Secretary determines that such expansion is 
        expected to--
                    (A) reduce spending under title XVIII of the Social 
                Security Act without reducing quality of care; or
                    (B) improve the quality of care for individuals 
                enrolled under part B of such title without increasing 
                spending under such title;
            (2) the Chief Actuary of the Centers for Medicare & 
        Medicaid Services certifies that such expansion would reduce 
        (or would not result in any increase in) net program spending 
        under such title; and
            (3) the Secretary determines that such expansion would not 
        deny or limit the coverage or provision of benefits under such 
        title for individuals enrolled under part B of such title.
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