A bill to amend title XVIII of the Social Security Act to improve access to diabetes self management training by designating certified diabetes educators who are recognized by a nationally recognized certifying body and who meet the same quality standards set forth for other providers of diabetes self management training, as certified providers for purposes of outpatient diabetes self-management training services under part B of the medicare program.

Summary: Diabetes Self Management Training Act of 2005 - 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 the barriers that exist for individuals with diabetes in accessing diabetes self-management training.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Diabetes Self Management Training 
Act of 2005''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Diabetes is widely recognized as one of the top public 
        health threats facing our Nation today. More than 18,000,000 
        Americans are currently living with diabetes and that number is 
        expected to double by the year 2050. Diabetes is the sixth 
        leading cause of death in the United States, causing more than 
        200,000 deaths each year.
            (2) Diabetes occurs in two forms. Type 1 diabetes is caused 
        by the body's inability to produce insulin, a hormone that 
        allows glucose to enter and fuel cells. Type 2 diabetes occurs 
        when the body fails to make enough insulin or fails to properly 
        use it. Type 1 diabetes typically develops in childhood or 
        adolescence and accounts for only 5 to 10 percent of cases of 
        diabetes. Type 2 diabetes accounts for 90 to 95 percent of 
        diabetes cases and most often appears among people older than 
        40. It is especially common in the medicare population, as 1 in 
        5 adults over age 65 has type 2 diabetes.
            (3) Diabetes is a costly disease. In 2002, diabetes 
        accounted for $132,000,000,000 in direct and indirect health 
        care costs. It is especially costly for the medicare program. 
        Individuals with diabetes represent approximately 20 percent of 
        medicare beneficiaries but account for more than 30 percent of 
        fee-for-service medicare expenditures.
            (4) People with type 1 diabetes are required to take daily 
        insulin injections to stay alive. While some people with type 2 
        diabetes need daily insulin injections, others with type 2 
        diabetes can control their diabetes through healthy meal plans, 
        exercise, and, for some, oral medications. Diabetes self 
        management training (in this section referred to as ``DSMT''), 
        also called diabetes education, provides knowledge and skills 
        training to patients with diabetes, helping them identify 
        barriers, facilitate problem solving, and develop coping skills 
        to effectively manage their diabetes. 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) DSMT has been proven effective in helping to reduce the 
        risks and complications of diabetes. 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, such as those taught in DSMT programs, 
        reduced their risk of getting type 2 diabetes by 58 percent. 
        Lifestyle intervention worked in all of the groups but it 
        worked particularly well in people aged 60 and older, reducing 
        the development of diabetes by 71 percent. Similarly, studies 
        have found that patients under the care of a certified diabetes 
        educator are better able to control their diabetes and report 
        improvement in their health status. Congress recognized the 
        value of DSMT by creating medicare coverage for this benefit 
        under the Balanced Budget Act of 1997.
            (6) There are currently more than 20,000 diabetes educators 
        in the United States, most of whom are certified diabetes 
        educators credentialed by the National Certification Board for 
        Diabetes Educators (NCBDE). Eligibility for certification as a 
        diabetes educator requires prerequisite qualifying professional 
        credentials in specified health care professions and 
        professional practice experience that includes a minimum number 
        of hours of experience in DSMT. Certified diabetes educators 
        must also pass a rigorous national examination and periodically 
        renew their credentials. Certified diabetes educators are 
        uniquely qualified to provide DSMT under the medicare program.

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 ``, or a 
                certified diabetes educator (as defined in paragraph 
                (3)) who is credentialed by a nationally recognized 
                certifying body for diabetes educators'' before the 
                semicolon at the end; and
                    (B) in subparagraph (B), by striking ``a 
                physician'' through ``meets applicable'' and inserting 
                the following: ``a physician, or such other individual 
                or entity, or a certified diabetes educator meets the 
                quality standards described in this paragraph if the 
                physician, other individual or entity, or certified 
                diabetes educator meets quality standards established 
                by the Secretary, except that the physician, other 
                individual or entity, or certified diabetes educator 
                shall be deemed to have met such standards if the 
                physician, other individual or entity, or certified 
                diabetes educator meets applicable''; and
            (2) by adding at the end the following new paragraph:
    ``(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 met all criteria for initial certification, 
        including a prerequisite qualifying professional credential in 
        a specified health care profession, has professional practice 
        experience in diabetes self-management training that includes a 
        minimum number of hours of diabetes self-management training, 
        and has passed a national examination offered by a certifying 
        body recognized as entitled to grant certification to 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 (1).
    (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.