[Congressional Record Volume 151, Number 18 (Thursday, February 17, 2005)]
[Senate]
[Pages S1655-S1656]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BUNNING (for himself and Ms. Mikulski):
  S. 440. 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 reintroduce an important 
bill that will ensure that Medicaid beneficiaries in all states have 
access to the services of top-quality podiatric physicians. I am 
pleased that Senator Mikulski from Maryland is joining me in 
introducing this bill today.
  Having healthy feet and ankles are critical to keeping individuals 
mobile, productive and in good long-term health. This is particularly 
true for individuals with diabetes.
  According to the Centers for Disease Control and Prevention, CDC, 
over 18 million Americans have diabetes, and it is the sixth leading 
cause of death in this country. Each year, over 200,000 Americans die 
from this disease.
  If not managed properly, diabetes can cause several severe health 
problems, including eye disease or blindness, kidney disease and heart 
disease. Too often, diabetes can lead to foot complications, including 
foot ulcers and even amputations. In fact, the CDC estimates that 
82,000 people undergo an amputation of a leg, foot or toe each year 
because of complications with diabetes.
  Proper care of the feet could prevent many of these amputations. The 
CDC says that regular exams and patient education could prevent up to 
85 percent these amputations.
  The bill we are introducing today recognizes the important role 
podiatrists can play identifying and correcting foot problems among 
diabetics. The bill amends 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 podiatric services are 
not needed, or that beneficiaries will not seek out other providers to 
perform these services. 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.
  Also, it is important to note that 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. It will help many Medicaid beneficiaries across the country have 
access to podiatrists that they need.
  Finally, I 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

[[Page S1656]]

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.
  The services of podiatrists are considered optional under Medicaid. 
Currently, most state Medicaid programs, including Maryland, recognize 
and reimburse podiatrists for providing foot and ankle care to their 
beneficiaries. However, during times of tight budgets, states may 
choose to cut back on these optional services. Recently, Connecticut, 
and Texas discontinued podiatric services. Even though podiatrist 
services are considered optional, Medicaid patients need foot and ankle 
care. 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.
  The President's budget challenges Congress to make major cuts to 
Medicaid--up to $60 billion. Covering podiatrists may be, in fact, a 
cost cutting measure. Ensuring Medicaid patient access to podiatrists 
will 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 of the 
American Podiatric Medical Association. I urge my colleagues to 
cosponsor this important legislation.
                                 ______