[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4094 Introduced in Senate (IS)]

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118th CONGRESS
  2d Session
                                S. 4094

To amend title XVIII of the Social Security Act to provide for coverage 
  of the Medicare Diabetes Prevention program, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 10, 2024

 Mr. Scott of South Carolina (for himself, Mr. Warner, and Mr. Cramer) 
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 provide for coverage 
  of the Medicare Diabetes Prevention program, 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 ``Promoting Responsible and Effective 
Virtual Experiences through Novel Technology to Deliver Improved Access 
and Better Engagement with Tested and Evidence-based Strategies Act'' 
or the ``PREVENT DIABETES Act''.

SEC. 2. MEDICARE DIABETES PREVENTION PROGRAM.

    (a) Coverage.--
            (1) In general.--Section 1861 of the Social Security Act 
        (42 U.S.C. 1395x) is amended--
                    (A) in subsection (s)(2), by adding at the end the 
                following new subparagraph:
            ``(KK) diabetes prevention program services (as defined in 
        subsection (nnn));''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(nnn) Diabetes Prevention Program Services.--
            ``(1) In general.--The term `diabetes prevention program 
        services' means structured behavioral health change sessions 
        that--
                    ``(A) are furnished to an eligible individual 
                described in paragraph (2) by a diabetes prevention 
                program supplier for the purpose of preventing or 
                delaying the onset of type II diabetes;
                    ``(B) follow a CDC-approved curriculum; and
                    ``(C) are furnished on or after January 1, 2025.
            ``(2) Eligible individual described.--An eligible 
        individual described in this paragraph is an individual that--
                    ``(A) is entitled to benefits under part A and is 
                enrolled under part B;
                    ``(B) has no previous diagnosis of diabetes (other 
                than gestational diabetes);
                    ``(C) does not have end-stage renal disease; and
                    ``(D) meets additional medical criteria specified 
                by the Secretary.
            ``(3) No lifetime limit on participation.--There shall be 
        no limitation on the number of times an eligible individual may 
        enroll in the diabetes prevention program.''.
            (2) Conforming change.--Section 1862(a)(1) of the Social 
        Security Act (42 U.S.C. 1395y(a)(1)) is amended--
                    (A) in subparagraph (O), by striking ``and'' at the 
                end;
                    (B) in subparagraph (P), by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(Q) in the case of diabetes prevention program services 
        (as defined in section 1861(nnn)(1)), which are furnished to an 
        individual who is not an eligible individual (as defined in 
        section 1861(nnn)(2));''.
    (b) Diabetes Prevention Program Suppliers.--Section 1866 of the 
Social Security Act (42 U.S.C. 1395cc) is amended by adding at the end 
the following new subsection:
    ``(l) Diabetes Prevention Program Suppliers.--
            ``(1) Diabetes prevention program supplier.--In this 
        subsection, the term `diabetes prevention program supplier' 
        means an entity that--
                    ``(A) is recognized under the Centers for Disease 
                Control and Prevention Diabetes Prevention Recognition 
                Program and offers a program through an allowable 
                Diabetes Prevention Recognition Program delivery mode 
                including in-person, online, distance learning, 
                combination, and other synchronous and asynchronous 
                modalities as determined by the Secretary;
                    ``(B) is enrolled under the diabetes prevention 
                program in accordance with paragraph (2); and
                    ``(C) meets the requirements described in paragraph 
                (2)(B).
            ``(2) Enrollment in diabetes prevention program.--
                    ``(A) Application.--An entity seeking to enroll as 
                a diabetes prevention program supplier under this 
                section shall submit to the Secretary an application 
                for enrollment at such time and in such manner as 
                specified by the Secretary. Such application must meet 
                all elements as specified by the Secretary.
                    ``(B) Requirements.--
                            ``(i) Administrative requirements.--Each 
                        diabetes prevention program supplier shall 
                        maintain--
                                    ``(I) administrative requirements 
                                as outlined by the Secretary;
                                    ``(II) active enrollment as a 
                                diabetes prevention program supplier 
                                under subsection (j); and
                                    ``(III) at least one administrative 
                                location.
                            ``(ii) Documentation; data submission.--
                                    ``(I) Documentation.--Each diabetes 
                                prevention program supplier shall 
                                maintain documentation in accordance 
                                with standards specified by the 
                                Secretary.
                                    ``(II) Data submission.--Each 
                                diabetes prevention program supplier 
                                shall maintain information as specified 
                                by the Secretary and submit it to the 
                                Secretary in the form and manner 
                                specified by the Secretary.
                            ``(iii) Inspection and review 
                        requirements.--Each diabetes prevention program 
                        supplier shall allow the Secretary, or any 
                        person or organization designated by the 
                        Secretary, to conduct inspections of any 
                        administrative location of a diabetes 
                        prevention program supplier, or of any eligible 
                        setting in which diabetes prevention program 
                        services are furnished, as well as review all 
                        documentation and records maintained by such 
                        supplier for purposes of the diabetes 
                        prevention program.
                    ``(C) Diabetes prevention program supplier 
                termination.--The Secretary may terminate the 
                enrollment of a diabetes prevention program supplier 
                for purposes of participation in the diabetes 
                prevention program if such supplier--
                            ``(i) fails to meet the requirements 
                        described in subparagraph (B);
                            ``(ii) improperly denies services to an 
                        eligible individual (as defined in section 
                        1861(nnn)(2)), including a denial on the basis 
                        of an eligible individual's weight, health 
                        status, or achievement of performance goals; or
                            ``(iii) fails to comply with additional 
                        standards established by the Secretary.
            ``(3) Administrative location defined.--In this subsection, 
        the term `administrative location' means a physical location in 
        which a diabetes prevention program supplier is the primary 
        operator of such location or the location from which the 
        diabetes prevention program supplier's business is run in the 
        case of an online or combination program, and where in-person 
        diabetes prevention program services may or may not be 
        furnished.''.
    (c) Payment for Diabetes Prevention Program Services.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and (HH)'' and inserting 
                ``(HH)''; and
                    (B) in subparagraph (HH), by striking the semicolon 
                at the end and inserting the following: ``, and (II) 
                with respect to diabetes prevention program services 
                furnished on or after January 1, 2025, as described in 
                section 1861(nnn), the amount paid shall be equal to 
                100 percent of the payment amount established in the 
                payment structure described in section 1834(aa);''.
            (2) Payment structure.--Section 1834 of the Social Security 
        Act (42 U.S.C. 1395m) is amended by adding at the end the 
        following subsection:
    ``(aa) Payment for Diabetes Prevention Program Services.--
            ``(1) In general.--The Secretary shall establish an 
        appropriate payment structure under which the Secretary shall 
        make payments to a diabetes prevention program supplier for 
        diabetes prevention program services furnished to an eligible 
        individual (as defined in section 1861(nnn)(2)).
            ``(2) Annual update.--The Secretary shall update the 
        payment structure under this subsection annually by the 
        percentage increase in the Consumer Price Index for all urban 
        consumers (all items; United States city average) for the 12-
        month period ending with June of the preceding year.
            ``(3) Termination of participation.--
                    ``(A) In general.--A diabetes prevention program 
                supplier may terminate the participation of an 
                individual participating in the diabetes prevention 
                program if the individual is no longer an eligible 
                individual (as defined in section 1862(nnn)(2)).
                    ``(B) Documentation supporting termination.--In the 
                case of a diabetes prevention program supplier that 
                terminates the participation of an individual 
                participating in the diabetes prevention program, such 
                supplier shall maintain records supporting such 
                termination, including the date of the termination, the 
                reason for the termination, the details of any 
                incidents leading to such termination, any remediation 
                efforts taken by such supplier, and any final actions 
                taken by such supplier.
            ``(4) Continuation of medicare diabetes prevention program 
        expanded model standards.--Except as specified otherwise in 
        this Act, the Secretary shall extend the standards of the 
        Medicare Diabetes Prevention Program Expanded Model (in effect 
        as of the date of enactment of the PREVENT DIABETES Act) to 
        govern the diabetes prevention program.
            ``(5) Diabetes prevention program.--In this subsection, the 
        term `diabetes prevention program' means the payment structure 
        described in this subsection.''.

SEC. 3. SUNSET OF MDPP EXPANDED MODEL.

    No payment shall be made for services furnished under the Medicare 
Diabetes Prevention Program Expanded Model conducted under section 
1115A of the Social Security Act (42 U.S.C. 1315a) after January 1, 
2025.

SEC. 4. UPDATE TO REGULATIONS.

    Not later than November 30, 2024, the Secretary of Health and Human 
Services shall update the regulations in sections 410.79, 414.84, 
424.200, and 424.205 of title 42, Code of Federal Regulations, and any 
other relevant regulations, in accordance with sections 2 and 3 of this 
Act.

SEC. 5. REPORT.

    Not later than January 1, 2028, the Secretary of Health and Human 
Services shall submit to Congress a report on the diabetes prevention 
program. Such report shall include a description of the impact of such 
program on--
            (1) participation of eligible individuals and diabetes 
        prevention program suppliers in the diabetes prevention program 
        as compared to the Medicare Diabetes Prevention Program 
        Expanded Model;
            (2) weight loss among eligible individuals;
            (3) health outcomes of eligible individuals; and
            (4) diagnoses and costs relating to type 2 diabetes for 
        eligible individuals who have received diabetes prevention plan 
        services versus those who have not.
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