[Congressional Record Volume 171, Number 84 (Monday, May 19, 2025)]
[Senate]
[Pages S2973-S2974]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

             By Ms. COLLINS (for herself and Mrs. SHAHEEN):

  S. 1805. 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 the Promoting 
Access to Diabetic Shoes Act with my colleague from New Hampshire, 
Senator Shaheen. I want to thank Senator Shaheen for her partnership on 
so many issues affecting individuals with diabetes. Our bipartisan bill 
would allow nurse practitioners and physician assistants to prescribe 
therapeutic shoes under Medicare. This will enable Medicare 
beneficiaries who have diabetes to more easily access this important 
preventive care, should they need it.
  As cochairs of the Senate Diabetes Caucus, Senator Shaheen and I are 
focused on advancing policies that will improve the lives of the more 
than 37 million Americans who live with diabetes. Therapeutic shoes 
help prevent some of the costly and painful complications related to 
diabetes, such as foot ulcers, which almost 1.6 million individuals 
with diabetes have. If they do not receive timely care, these 
individuals are at risk of serious health complications, such as lower 
limb amputations. Only 10 percent of qualifying Medicare patients 
receive the diabetic shoes they need because of difficulties accessing 
qualifying providers. By reducing barriers to this preventive care, the 
Promoting Access to Diabetic Shoes Act will enable more individuals 
with diabetes to receive the medical care they need to avoid some 
serious complications.
  Nurse practitioners and physician assistants in Maine and across the 
country provide the full range of care to patients with diabetes. Many 
patients see an NP or a PA as their preferred primary care provider for 
treating diabetes. When the treating NP or PA determines that the 
patient may need therapeutic shoes, however, the NP or PA must send the 
patient first to a physician to make the same determination, and then 
the physician must send them to a podiatrist to actually fit the shoes. 
To make matters more complicated, under current law, the certifying 
physician must take over all treatment of the patients diabetic 
condition. This process not only forces a patient to change providers 
but also delays patient access to effective treatment for diabetes.
  In rural States such as Maine, patients often have to drive long 
distances to see a podiatrist or even a physician. One nurse 
practitioner from Bangor shared with me that the closest podiatrist she 
is able to send patients to is an hour-long drive away and has a many-
months long waitlist. Patients with diabetes simply cannot afford to 
wait months and months for treatment. The removal of this outdated and 
unnecessary barrier means NPs and PAs would be authorized to certify 
the need for therapeutic shoes for patients with diabetes and ensure 
they get the care they need in a timely fashion.
  Finally, passage of this legislation will reduce Medicare spending by 
removing the unnecessary and duplicative certifying visit requirements. 
Data demonstrate that NPs and PAs manage the care for patients with 
diabetes in a cost-effective manner that results in healthcare savings. 
The estimated total annual cost of an individual patient with diabetes 
is $17,000. If the patient does not receive treatment in

[[Page S2974]]

time, though, and develops a serious complication, the estimated annual 
individual cost rises to $52,000. Our bill will create savings for 
Medicare by reducing the long-term costs of care.
  Passage of the Promoting Access to Diabetic Shoes Act will make it 
possible for NPs and PAs to continue providing high-quality care for 
their Medicare patients with diabetes. It will also reduce Medicare 
spending by eliminating duplicative services, improve the timeliness of 
care for patients with diabetes who need therapeutic shoes, and allow 
the patient to continue receiving care from the provider of their 
choice. I urge all of my colleagues to join Senator Shaheen and me in 
supporting the Promoting Access to Diabetic Shoes Act.

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