[Congressional Record Volume 150, Number 70 (Tuesday, May 18, 2004)]
[Senate]
[Pages S5609-S5610]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. NELSON of Nebraska (for himself and Mrs. Hutchinson):
S. 2431. A bill to amend title XVIII of the Social Security Act to
improve access to diabetes self-management training by designating
certified diabetes educators recognized by the National Certification
Board of Diabetes Educators as certified providers for purposes of
outpatient diabetes education services under part B of the medicare
program; to the Committee on Finance.
Mr. NELSON of Nebraska. Mr. President, today I introduce an important
piece of legislation that will correct an oversight from the Balanced
Budget Act of 1997. In 1997, Congress created a new diabetes benefit
under Medicare--diabetes self-management training--but did not create a
new provider group to deliver it. Congress assumed that the existing
diabetes education programs in hospitals would be able provide services
to all who were in need.
Certified Diabetes Educators, CDEs, were not given the ability to
bill Medicare directly for diabetes self-management training when
Congress passed the new benefit in 1997 because they did not feel there
was a need to create a new provider since CDEs could work within a
hospital setting and receive reimbursement through hospital billing.
However, due to changing health care economics, hospital diabetes self-
management training programs have been closing at an alarming rate,
forcing patients to seek other avenues for obtaining diabetes self-
management training, such as clinics and stand-alone programs.
While small in scope, the Diabetes Self-Management Training Act of
2004 will correct this oversight to ensure our Nation's seniors with
diabetes have access to this important benefit.
Diabetes education is very important in my State of Nebraska.
According to the Nebraska Health and Human Services System, about five
percent of Nebraska's adults have diagnosed diabetes--or about 60,000
people. An additional 20,000 Nebraskans probably have diabetes but have
not been diagnosed. While diabetes rates continue to grow at an
alarming rate, lack of access to diabetes-self management training,
which is critical to controlling diabetes and preventing secondary
complications, has also become a chronic problem. Despite the fact that
twenty percent of Medicare patients have diabetes, and about a quarter
of all Medicare spending goes to treat diabetes and diabetes-related
conditions, less than one-third of eligible patients are currently
receiving the benefit.
Because CDEs are not able to bill Medicare directly for diabetes
self-management training, patients have limited options for obtaining
the training they need to successfully manage their disease and prevent
expensive and debilitating complications. The potential for
complications is enormous. If patients with diabetes cannot gain access
to diabetes self-management training, serious complications will arise,
such as kidney disease, amputations, vision loss, and severe cardiac
disease. In fact, half of all Medicare dialysis patients suffer from
diabetes.
By improving access to this important benefit, I believe we will take
an important step toward helping patients control their diabetes, which
will not only save the Medicare program the significant costs
associated with the complications from uncontrolled diabetes, but more
importantly it will dramatically improve the quality of life for the
millions of Medicare beneficiaries with diabetes. That is why I am so
proud to introduce this bi-partisan legislation, the Diabetes Self-
Management Training Act of 2004, along with my colleague Senator
Hutchison.
Throughout the Medicare debate last year, one of the top
considerations for all Senators was the cost of the legislation and the
long-term solvency of the Medicare program. In fact, we passed new
programs in that legislation to begin studying new health care delivery
models like Medicare that will improve the outcomes for beneficiaries
with chronic diseases. While I strongly supported those new
demonstration programs, we need not wait to begin helping our seniors.
With diabetes already directly affecting so many seniors, and the
baby boomers on the horizon, we cannot afford to deny seniors access to
proven programs like diabetes self-management training any longer. I
look forward to working to pass this legislation and help those with
diabetes.
Mrs. HUTCHISON. Mr. President, I rise today with Senator Nelson to
introduce an important piece of legislation that will dramatically
improve the quality of diabetes care under the Medicare program.
Diabetes is a serious, debilitating chronic illness that afflicts
more than 18 million Americans, including eight million Medicare
beneficiaries. An additional eight million seniors suffer from a
condition known as ``pre-diabetes'' that, when left untreated, will
develop into diabetes. Diabetes' devastating complications--kidney
failure, blindness, lower extremity amputation, heart disease and
stroke--result in significant costs to the program. Although
beneficiaries with diabetes comprise only 20 percent of the Medicare
population, diabetes related complications account for more than 30
percent of medicare expenditures.
This is indeed troubling, and there is much that can be done to
reduce the burden of diabetes and prevent these costly complications.
Diabetes self-management training, DSMT, helps people with diabetes
learn the skills they need to manage the daily regimen of diet,
exercise, meal planning, medication and monitoring necessary to keep
blood sugar under control. Certified Diabetes Educators, CDEs, are
highly trained healthcare professionals--often nurses, pharmacists, or
dieticians--who specialize in helping people with diabetes develop
these skills. A CDE must be a licensed health care professional,
possess a minimum of two years of professional practice experience in
DSMT, have provided a minimum of 1,000 hours of DSMT to patients in the
past five years, and have passed a rigorous national examination.
The value of DSMT is well documented. The Diabetes Prevention Program
study of 2002 demonstrated that participants, all of whom were at
increased risk for developing type 2 diabetes, were able to reduce that
risk by implementing the lifestyle changes taught as part of DSMT.
Additional studies have found that patients with diabetes achieved
significantly better outcomes when taking part in comprehensive
diabetes management programs.
Congress recognized the value of DSMT when it provided for this
benefit under the Balanced Budget Act of 1997. At that time, CDEs were
able to provide DSMT through hospital-based programs, billing under the
hospital's provider number. Unfortunately, hospital-based DSMT programs
are closing at a rate of two to five per month, leaving people with
diabetes without access to this life-saving benefit. Our legislation
would correct this problem by allowing CDEs to be recognized as
providers under the Medicare program for the purposes of providing
DSMT. This would provide CDEs with the flexibility they need to ensure
that beneficiaries can access these critical services.
As it is, the Centers for Medicaid and Medicare Services, CMS,
estimates that only 30 percent of beneficiaries are utilizing the
benefit. More must be done to increase access to life-saving DSMT
programs. Our legislation will help to accomplish that goal.
Diabetes already poses a serious burden for the Medicare program. As
the 76 million baby-boomers age into the Medicare program, the cost of
diabetes related complications could seriously undermine the financial
stability of the Medicare program. We must act now to strengthen
Medicare to ensure that beneficiaries with diabetes have the tools they
need to prevent diabetes complications.
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