[Congressional Record Volume 151, Number 31 (Tuesday, March 15, 2005)]
[Senate]
[Page S2740]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. NELSON of Nebraska (for himself and Mrs. Hutchison):
  S. 626. A bill to amend title XVIII of the Social Security Act to 
improve-access to diabetes self management training by designating 
certified diabetes educators who are recognized by a nationally 
recognized certifying body and who meet the same quality standards set 
forth for other providers of diabetes self management training, as 
certified providers for purposes of outpatient diabetes self-management 
training 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 to 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 because 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 
2005 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 sever 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 2005, along with my 
colleague Senator Hutchison.
  Throughout the Medicare debate in 2003, 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 that 
will improve the outcomes for beneficiaries with chronic diseases like 
Medicare. 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.
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