[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1840 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 1840
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
March 21, 2019
Mr. Reed (for himself, Ms. DeGette, Mr. Ruiz, Ms. DelBene, Mrs. Brooks
of Indiana, and Mr. Kelly of Pennsylvania) 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 2019'' or the ``Expanding Access to DSMT Act
of 2019''.
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 (CC)'' and inserting
``(CC)''; and
(B) by striking the semicolon at the end and
inserting ``, and (DD) 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,
2020.
SEC. 3. VIRTUAL DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES
DEMONSTRATION PROGRAM.
(a) In General.--Beginning not later than January 1, 2020, 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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