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 2003 - Amends title XVIII (Medicare) of the Social Security Act to provide for the recognition of certified diabetes educators as Medicare providers for purposes of diabetes outpatient self-management training services.

Directs the Comptroller General to study and report to Congress on: (1) the barriers, if any, that exist in rural areas to successfully becoming a recognized diabetes education program, including the difficulty of rural heath care professionals in becoming certified diabetes educators; and (2) whether individuals with diabetes who live in rural areas have barriers to accessing diabetes self-management training.

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.