[Congressional Record Volume 150, Number 28 (Monday, March 8, 2004)]
[Senate]
[Pages S2304-S2305]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BUNNING (for himself and Ms. Mikulski):
   S. 2174. A bill to amend title XIX of the Social Security Act to 
include podiatrists as physicians for purposes of covering physicians 
services under the medicaid program; to the Committee on Finance.
   Mr. BUNNING. Mr. President, I rise today to introduce a very 
important piece of legislation with Senator Mikulski from Maryland. Our 
bill will ensure that Medicaid beneficiaries in all States have access 
to the services of top-quality podiatric physicians.
   Podiatrists play a vital roll in keeping feet and ankles healthy. 
This is critical to keeping people mobile and productive, which is a 
key to good long-term health.
   Proper foot care is particularly important for individuals with 
diabetes, which is a severe problem in my State. According to the 
Centers for Disease Control and Prevention (CDC), 18.2 million people--
or 6.3 percent of the population--have diabetes in this country, and it 
is the sixth leading cause of death. If not managed properly, diabetes 
can cause several severe health problems, including blindness, kidney 
disease and heart disease. Too often, diabetes can lead to foot 
complications, including foot ulcers and even amputations.
   In fact, the CDC estimate that ``more than 60 percent of 
nontraumatic lower-limb amputations occur among people with diabetes,'' 
which equals about 82,000 amputations a year.
   These numbers are startling.
   Podiatrists, however, can play a vital role in recognizing and 
correcting foot problems among diabetics to help avoid amputations and 
other complications.
   Our bill is fairly simple. It amends the Medicaid's definition of 
``physicians'' to include podiatric physicians. This will ensure that 
Medicaid beneficiaries have access to foot care from those most 
qualified to provide it.
   Under Medicaid, podiatry is considered an optional benefit. However, 
just because it is optional, doesn't mean that the need for these 
services is

[[Page S2305]]

eliminated or that the services aren't performed by other providers. 
Instead, Medicaid beneficiaries will have to receive foot care from 
other providers who may not be as well trained as a podiatrist in 
treating lower extremities.
   According to the American Podiatric Medical Association, 43 States 
currently recognize and reimburse podiatrists under their Medicaid 
problems. Also, podiatrists are considered physicians under the 
Medicare program, which allows seniors and disabled individuals to 
receive appropriate care.
   I urge my colleagues to give careful consideration to this important 
bill and to support it. It will help many Medicaid beneficiaries across 
the country have the guaranteed access to podiatrists that they need.
   Finally, I want to thank the Senator from Maryland for helping me 
introduce this legislation today. I hope that by working together we 
can see this important change made.
  Ms. MIKULSKI. Mr. President, I rise to join Senator Bunning to 
introduce this important bill to make sure that Medicaid patients have 
access to care provided by podiatrists.
  This bill ensures that Medicaid patients across the country can get 
services provided by podiatrists. This is a simple, common sense bill. 
This legislation includes podiatric physicians in Medicaid's definition 
of physician. This means that the services of podiatrists will be 
covered by Medicaid, just like they are in Medicare. Podiatrists are 
considered physicians under Medicare. They should be under Medicaid. 
Medicaid covers necessary foot and ankle care services. Medicaid should 
allow podiatrists who are trained specifically in foot and ankle care 
to provide these services and be reimbursed for them.
  Currently, the services of podiatrists are considered optional under 
Medicaid. The Medicaid programs in 43 States, including Maryland, 
recognize and reimburse podiatrists for providing foot and ankle care 
to their beneficiaries. During times of tight budgets, States may cut 
back on these optional services. Last year Connecticut, Michigan, Utah 
and Texas discontinued podiatric services. Even though podiatrist 
services are considered optional, Medicaid patients need foot and ankle 
care regardless. If podiatrists do not provide the care, patients will 
see providers who may not be as well trained in the care of the lower 
extremities as podiatrists. I want the over 560,000 Medicaid patients 
in Maryland to have access to the services provided by over 400 
podiatrists in Maryland.
  Podiatrists receive special training on the foot, ankle and lower 
leg. They play an important role in the recognition of systemic 
diseases like diabetes, and in the recognition and treatment of 
peripheral neuropathy, a frequent cause of diabetic foot wounds that 
can often lead to preventable lower extremity amputations. Over 18 
million people in this country have diabetes, but an estimated more 
than 5 million of these people are not aware that they have the 
disease.
  Ensuring Medicaid patient access to podiatrists could save Medicaid 
funds in the long term. According to the American Podiatric Medical 
Association, 75 percent of Americans will experience some type of foot 
health problem during their lives. Foot disease is the most common 
complication of diabetes leading to hospitalization. About 82,000 
people have diabetes-related leg, foot or toe amputations each year. 
Foot care programs with regular examinations and patient education 
could prevent up to 85 percent of these amputations. Podiatrists are 
important providers of this care.
  This bill will make sure that Medicaid patients across the country 
have access to care provided by podiatrists. It has the support the 
American Podiatric Medical Association. I urge my colleagues to 
cosponsor this important legislation.
                                 ______