[Congressional Record Volume 153, Number 15 (Thursday, January 25, 2007)]
[Senate]
[Page S1198]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BUNNING (for himself and Ms. Mikulski):
  S. 399. 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. Senator 
Mikulski from Maryland is joining me in the effort again this year, and 
I appreciate her dedication to this issue.
  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, 
almost 21 million Americans have diabetes, which amounts to about 7 
percent of the total population. Diabetes is the sixth leading cause of 
death in this country. In 2005, 1.5 million Americans were diagnosed 
with diabetes.
  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 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 reintroduce 
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.
  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 budget States may choose 
to cut back on these optional services. There are now 7 States where 
access to a podiatrist is limited or nearly impossible for someone who 
receives Medicaid. 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 to make sure the over 750,000 Medicaid patients in Maryland 
continue 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. Nearly 21 
million Americans are now living with diabetes, a 14 percent increase 
from the 18 million in 2003. Another 41 million have pre-diabetes, the 
condition that indicates an increased risk for developing both type 2 
diabetes and cardiovascular disease. Both the CDC and the American 
Diabetes Association recommend that podiatric physicians be part of the 
care term for people with diabetes.
  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. This alone could 
have saved $1.3 billion in savings for Medicare and $386 million in 
savings for Medicaid. 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 and gained broad bi-partisan 
support in both the House and Senate last Congress. 29 Senators co-
sponsored S. 440, including nearly half the members of the Finance 
Committee. The House companion bill, HR 699 had 210 co-cosponsors, 
including 68 percent of the committee with primary jurisdiction, Energy 
and Commerce. I urge my colleagues to cosponsor this important 
legislation.
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