[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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