[Congressional Record Volume 164, Number 99 (Thursday, June 14, 2018)]
[Senate]
[Pages S3953-S3954]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BROWN (for himself and Ms. Collins):
  S. 3067. A bill to amend title XVIII of the Social Security Act to 
permit nurse practitioners and physician assistants to satisfy the 
documentation requirement under the Medicare program for coverage of 
certain shoes for individuals with diabetes; to the Committee on 
Finance.
  Ms. COLLINS. Mr. President, I rise today to introduce legislation 
with my colleague from Ohio, Senator Sherrod Brown, that would remove 
an unnecessary, outdated barrier for Medicare beneficiaries managing 
diabetes. Our legislation would allow physician assistants (PAs) and 
nurse practitioners (NPs) to satisfy the Medicare documentation 
requirement certifying a patient's need for therapeutic, or diabetic, 
shoes, which will improve access to care, reduce barriers to proper 
diabetic management, and help to reduce the prevalence of costly 
complications that can arise if diabetic symptoms are not managed 
properly. This bipartisan bill, the Promoting Access to Diabetic Shoes 
Act, is a companion to H.R. 1617 from my fellow Diabetes Caucus Co-
Chair, Representative Tom Reed of New York, which has growing support 
on both sides of the aisle in the House.
  As the founder and co-chair of the Senate Diabetes Caucus, I have 
worked since the very beginning of my Senate service to increase 
awareness of the threats posed by diabetes, invest in research, and 
improve access to treatment options for the over 30 million Americans, 
including twelve million seniors, who suffer from diabetes. In addition 
to the human toll, diabetes is also the most expensive chronic illness 
in the country. A new American Diabetes Association report released in 
March titled, ``Economic Costs of Diabetes in the U.S. in 2017,'' found 
that the direct and indirect costs of diagnosed diabetes in the U.S. 
cost $327 billion in 2017, which is a 26 percent increase in just the 
last five years.
  Preventable complications contribute enormously to the influx of 
dollars being spent on diabetic care and

[[Page S3954]]

management. Today, more than one in five health care dollars and one in 
three Medicare dollars are spent on care for people with diabetes.
  Under the current Medicare statute, physician assistants or nurse 
practitioners are required to refer their patients with diabetes to a 
physician in order to certify the patient's need for therapeutic shoes, 
which often results in delays in treatment and added costs. The 
Promoting Access to Diabetic Shoes Act would fix this problem by 
allowing nurse practitioners and physician assistants to certify a 
Medicare beneficiary's need for therapeutic shoes, which will improve 
timeliness and access to care while reducing costs.
  Therapeutic shoes are a cost effective, preventive treatment option 
intended to avoid the costly complications that can arise if 
maintenance of diabetic care is delayed or unavailable. Types of 
complications that can result from unmanaged diabetic symptoms include 
poor circulation, infections, and foot ulcers that can require 
hospitalization, or even result in the amputation of toes, feet, or 
legs.
  In addition to preventable complications and additional costs that 
can result from delays in treatment, the current documentation 
requirement under Medicare can also disrupt the trusted patient-
provider relationship many patients have with an NP or PA. Current 
statute requires the certifying physician to be a patient's provider 
for diabetic care moving forward, which is often in conflict with a 
patient's preference. Moreover, in rural areas, including many parts of 
my home state of Maine, access to diabetic management though a PA or NP 
is not only necessary, but it is sometimes unavoidable due to the 
shortage of primary care providers in the area. Maine alone has 68 
designated Health Professional Shortage Areas for primary care 
practitioners. These health care professionals are already providing 
accessible, high quality diabetic care across the country. In fact, a 
March 2018 article in the American Journal of Medicine concluded that 
PAs and NPs are able to perform as well as physicians in the management 
of diabetes at diagnosis through the first five years of follow-up 
care.
  Stephanie Podolski, President of the Maine Association of Physician 
Assistants, which represents over 700 PAs in Maine, reiterated these 
points and the importance of the physician assistant profession in 
diabetes management in a letter of support for our bill saying, ``In a 
State like Maine, there are many rural communities that at times are 
served only by a PA as a primary care provider (PCP). The inability to 
order diabetic shoes is an outdated barrier to care that impacts both 
middle-aged and older Americans who frequently live in areas facing 
provider shortages.''
  The Promoting Access to Diabetic Shoes Act is endorsed by the 
American Association of Nurse Practitioners, the American Academy of 
Physician Assistants, and the American Podiatric Medical Association. I 
am pleased to join Senator Brown in introducing the Promoting Access to 
Diabetic Shoes Act, which will improve access to diabetic care, and I 
encourage my colleagues to support its adoption.

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