A bill 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.

Summary: Diabetes Self-Management Training Act of 2004 - Amends title XVIII (Medicare) of the Social Security Act to provide for recognition of certified diabetes educators as Medicare providers by a nationally recognized certifying body for diabetes educators for purposes of diabetes outpatient self-management training services.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Diabetes Self-Management Training 
Act of 2004''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Diabetes is the fifth leading cause of death in the 
        United States. Over 18,000,000 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) In 2002, the Diabetes Prevention Program study 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 20,000 diabetes educators in 
        the United States, most of whom are certified diabetes 
        educators (CDEs) credentialed by the National Certification 
        Board for Diabetes Educators (NCBDE). To earn a CDE 
        designation, a health care professional must be licensed or 
        registered, or have received an advanced degree in a relevant 
        public health concentration, have professional practice 
        experience and have met minimum hours requirements in diabetes 
        self-management training, and have met certification and 
        recertification requirements. 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.
            (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 credentialed by a nationally 
                recognized certifying body for diabetes educators and 
                who provides services within a diabetes self-management 
                training program that is lawfully operated under all 
                applicable Federal, State, and local laws and 
                regulations'' 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 credentialed 
                by a nationally recognized certifying body for diabetes 
                educators and who provides services within a diabetes 
                self-management training program that is lawfully 
                operated under all applicable Federal, State, and local 
                laws and regulations''; 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) has an advanced degree in a relevant public health 
        concentration or is a licensed or registered health care 
        professional, has met eligibility requirements for initial 
        certification, including meeting the minimum requirements for 
        professional practice experience and hours for diabetes self-
        management, and has passed a certification exam approved by a 
        nationally recognized certifying body for diabetes educators; 
        and
            ``(C) has periodically renewed certification status 
        following initial certification.''.
    (b) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study to identify the barriers that exist for 
        individuals with diabetes in accessing diabetes self-management 
        training, including economic and geographic barriers and 
        availability of appropriate referrals and access to adequate, 
        qualified providers.
            (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) shall 
apply to diabetes outpatient self-management training services 
furnished on or after the date that is 6 months after the date of 
enactment of this Act.