To amend title XVIII of the Social Security Act to improve access to diabetes self-management training by designating certified diabetes educators recognized by the National Certification Board of Diabetes Educators as certified providers for purposes of outpatient diabetes education services under part B of the Medicare Program.

September 25, 2003

Mr. WELDON of Pennsylvania (for himself and Ms. DEGETTE) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

To amend title XVIII of the Social Security Act to improve access to diabetes self-management training by designating certified diabetes educators recognized by the National Certification Board of Diabetes Educators as certified providers for purposes of outpatient diabetes education services under part B of the Medicare Program.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Diabetes Self-Management Training Act of 2003'.

SEC. 2. FINDINGS.

Congress makes the following findings:

(1) Diabetes is the fifth leading cause of death in the United States. Over 17,000,000 Americans (6.2 percent of the population) currently are living with diabetes, a number that is estimated to increase to 29,000,000 by the year 2050. In 2002, diabetes accounted for $132,000,000,000 in direct and indirect health care costs. Diabetes is widely recognized as one of the top public health threats facing our nation today.

(2) Diabetes can occur in 2 forms--type 1 diabetes is caused by the body's inability to produce insulin, a hormone that allows glucose or sugar to enter and fuel cells, and type 2 diabetes, which occurs when the body fails to make enough insulin, or fails to properly use it. People with type 1 diabetes are required to take daily insulin injections to stay alive. While some people with type 2 diabetes need insulin shots, others with type 2 diabetes can control their diabetes through healthy diet, nutrition, and lifestyle changes. Type 2 diabetes accounts for up to 95 percent of all diabetes cases affecting 8 percent of the population age 20 and older. The prevalence of type 2 diabetes has tripled in the last 30 years, with much of that increase due to an upsurge in obesity.

(3) The Diabetes Prevention Program study in 2002 found that participants (all of whom were at increased risk of developing type 2 diabetes) who made lifestyle changes reduced their risk of getting type 2 diabetes by 58 percent.

(4) Diabetes self-management training (DSMT) also called diabetes education, provides knowledge and skill training to patients with diabetes, helping them identify barriers, facilitate problem solving, and develop coping skills to effectively manage their diabetes. Unlike many other diseases, diabetes requires constant vigilance on the part of the patient and demands far more than just taking pills or insulin shots. A certified diabetes educator is a health care professional--often a nurse, dietitian, or pharmacist, who specializes in helping people with diabetes develop the self-management skills needed to stay healthy and avoid costly acute complications and emergency care, as well as debilitating secondary conditions caused by diabetes.

(5) There are currently over 13,000 diabetes educators in the United States, most of whom are certified diabetes educators (CDEs). To earn a CDE designation, a health care professional must be licensed or have received a masters degree in a relevant public health concentration, have completed 2 years of professional practice experience in diabetes self-management training, and have provided a minimum of 1000 hours of diabetes self-management training. Many other health care professionals that are able to bill for diabetes education through the medicare program have far less experience or ability to provide the skilled expertise to help people with diabetes self-manage the disease. CDEs are the best trained health care professionals to provide DSMT and their experience and background is in stark contrast to the 12 hours of continuing education that non-physician health care providers or suppliers must obtain every 2 years, as required by the Centers for Medicare & Medicaid Services.

(6) CDEs represent the only group of health care professionals who provide diabetes self-management training that have not been recognized as health care providers and are therefore precluded from directly billing the medicare program for DSMT. Adding CDEs as providers to that program would give diabetes patients access to the care they need.

SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDUCATORS AS MEDICARE PROVIDERS FOR PURPOSES OF DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES.

(a) IN GENERAL- Section 1861(qq) of the Social Security Act (42 U.S.C. 1395x(qq)) is amended--

(1) in paragraph (2)--

(A) in subparagraph (A), by inserting `and includes a certified diabetes educator (as defined in paragraph (3)) who is recognized by the National Certification Board of Diabetes Educators and is working within a recognized diabetes education program' before the semicolon at the end; and

(B) in subparagraph (B), by inserting before the period at the end the following: `or is a certified diabetes educator (as so defined) who is recognized by the National Certification Board of Diabetes Educators and is working within a recognized diabetes education program'; and

(2) by adding at the end the following:

`(3) For purposes of paragraph (2), the term `certified diabetes educator' means an individual who--

`(A) is a health care professional who specializes in helping individuals with diabetes develop the self-management skills needed to overcome the daily challenges and problems caused by the disease;

`(B) is a licensed nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician assistant, podiatrist, a registered dietitian, or has an advanced degree in nutrition, social work, clinical psychology, exercise physiology, health education or a related public health area such as health education, health promotion, health and social behavior or health communication;

`(C) has at least 2 years of professional practice experience in diabetes self-management training;

`(D) has provided a minimum of 1000 hours of diabetes self-management training to patients within the most recent 5 years; and

`(E) has passed a certification exam approved by the National Certification Board of Diabetes Educators.'.

(b) GAO STUDY AND REPORT-

(1) STUDY- The Comptroller General of the United States shall conduct a study to determine the barriers, if any, that exist in rural areas to successfully becoming a recognized diabetes education program, including the difficulty of rural health care professionals in becoming certified diabetes educators (as defined in section 1861(qq)(3) of the Social Security Act (as added by subsection (a)(2))), and whether individuals with diabetes who live in rural areas have barriers to accessing diabetes self-management training.

(2) REPORT- Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit a report to Congress regarding the study conducted under paragraph (2).

(c) EFFECTIVE DATE- The amendments made by subsection (a) apply to diabetes outpatient self-management training services furnished on or after October 1, 2003.

END