I 

118TH CONGRESS 

2D SESSION H. R. 7856 

To amend title XVIII of the Social Security Act to provide for coverage 

of the Medicare Diabetes Prevention program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 2, 2024 

Ms. DEGETTE (for herself, Mr. BILIRAKIS, and Mr. CROW) 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 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for coverage of the Medicare Diabetes Prevention program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Promoting Responsible 

5 and Effective Virtual Experiences through Novel Tech6 nology to Deliver Improved Access and Better Engage7 ment with Tested and Evidence-based Strategies Act’’ or 

8 the ‘‘PREVENT DIABETES Act’’. 


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1 SEC. 2. MEDICARE DIABETES PREVENTION PROGRAM. 

2 (a) COVERAGE.— 

3 (1) IN GENERAL.—Section 1861 of the Social 

4 Security Act (42 U.S.C. 1395x) is amended— 

5 (A) in subsection (s)(2), by adding at the 

6 end the following new subparagraph: 

7 ‘‘(KK) diabetes prevention program services (as 

8 defined in subsection (nnn));’’; and 

9 (B) by adding at the end the following new 

10 subsection: 

11 ‘‘(nnn) DIABETES PREVENTION PROGRAM SERV12 ICES.— 

13 ‘‘(1) IN GENERAL.—The term ‘diabetes preven14 tion program services’ means structured behavioral 

15 health change sessions that— 

16 ‘‘(A) are furnished to an eligible individual 

17 described in paragraph (2) by a diabetes pre18 vention program supplier for the purpose of 

19 preventing or delaying the onset of type II dia20 betes; 

21 ‘‘(B) follow a CDC-approved curriculum; 

22 and 

23 ‘‘(C) are furnished on or after January 1, 

24 2025. 


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1 ‘‘(2) ELIGIBLE INDIVIDUAL DESCRIBED.—An 

2 eligible individual described in this paragraph is an 

3 individual that— 

4 ‘‘(A) is entitled to benefits under part A 

5 and is enrolled under part B; 

6 ‘‘(B) has no previous diagnosis of diabetes 

7 (other than gestational diabetes); 

8 ‘‘(C) does not have end-stage renal disease; 

9 and 

10 ‘‘(D) meets additional medical criteria 

11 specified by the Secretary. 

12 ‘‘(3) NO LIFETIME LIMIT ON PARTICIPATION.— 

13 There shall be no limitation on the number of times 

14 an eligible individual may enroll in the diabetes pre15 vention program.’’. 

16 (2) CONFORMING CHANGE.—Section 1862(a)(1) 

17 of the Social Security Act (42 U.S.C. 1395y(a)(1)) 

18 is amended— 

19 (A) in subparagraph (O), by striking 

20 ‘‘and’’ at the end; 

21 (B) in subparagraph (P), by striking the 

22 semicolon at the end and inserting ‘‘, and’’; and 

23 (C) by adding at the end the following new 

24 subparagraph: 


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1 ‘‘(Q) in the case of diabetes prevention program 

2 services (as defined in section 1861(nnn)(1)), which 

3 are furnished to an individual who is not an eligible 

4 individual (as defined in section 1861(nnn)(2));’’. 

5 (b) DIABETES PREVENTION PROGRAM SUPPLIERS.— 

6 Section 1866 of the Social Security Act (42 U.S.C. 

7 1395cc) is amended by adding at the end the following 

8 new subsection: 

9 ‘‘(l) DIABETES PREVENTION PROGRAM SUP10 PLIERS.— 

11 ‘‘(1) DIABETES PREVENTION PROGRAM SUP12 PLIER.—In this subsection, the term ‘diabetes pre13 vention program supplier’ means an entity that— 

14 ‘‘(A) is recognized under the Centers for 

15 Disease Control and Prevention Diabetes Pre16 vention Recognition Program and offers a pro17 gram through an allowable Diabetes Prevention 

18 Recognition Program delivery mode including 

19 in-person, online, distance learning, combina20 tion, and other synchronous and asynchronous 

21 modalities as determined by the Secretary; 

22 ‘‘(B) is enrolled under the diabetes preven23 tion program in accordance with paragraph (2); 

24 and 


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1 ‘‘(C) meets the requirements described in 

2 paragraph (2)(B). 

3 ‘‘(2) ENROLLMENT IN DIABETES PREVENTION

4 PROGRAM.— 

5 ‘‘(A) APPLICATION.—An entity seeking to 

6 enroll as a diabetes prevention program supplier 

7 under this section shall submit to the Secretary 

8 an application for enrollment at such time and 

9 in such manner as specified by the Secretary. 

10 Such application must meet all elements as 

11 specified by the Secretary. 

12 ‘‘(B) REQUIREMENTS.— 

13 ‘‘(i) ADMINISTRATIVE REQUIRE14 MENTS.—Each diabetes prevention pro15 gram supplier shall maintain— 

16 ‘‘(I) administrative requirements 

17 as outlined by the Secretary; 

18 ‘‘(II) active enrollment as a dia19 betes prevention program supplier 

20 under subsection (j); and 

21 ‘‘(III) at least one administrative 

22 location. 

23 ‘‘(ii) DOCUMENTATION; DATA SUBMIS24 SION.— 


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1 ‘‘(I) DOCUMENTATION.—Each di2 abetes prevention program supplier 

3 shall maintain documentation in ac4 cordance with standards specified by 

5 the Secretary. 

6 ‘‘(II) DATA SUBMISSION.—Each 

7 diabetes prevention program supplier 

8 shall maintain information as speci9 fied by the Secretary and submit it to 

10 the Secretary in the form and manner 

11 specified by the Secretary. 

12 ‘‘(iii) INSPECTION AND REVIEW RE13 QUIREMENTS.—Each diabetes prevention 

14 program supplier shall allow the Secretary, 

15 or any person or organization designated 

16 by the Secretary, to conduct inspections of 

17 any administrative location of a diabetes 

18 prevention program supplier, or of any eli19 gible setting in which diabetes prevention 

20 program services are furnished, as well as 

21 review all documentation and records 

22 maintained by such supplier for purposes 

23 of the diabetes prevention program. 

24 ‘‘(C) DIABETES PREVENTION PROGRAM

25 SUPPLIER TERMINATION.—The Secretary may 


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1 terminate the enrollment of a diabetes preven2 tion program supplier for purposes of participa3 tion in the diabetes prevention program if such 

4 supplier— 

5 ‘‘(i) fails to meet the requirements de6 scribed in subparagraph (B); 

7 ‘‘(ii) improperly denies services to an 

8 eligible individual (as defined in section 

9 1861(nnn)(2)), including a denial on the 

10 basis of an eligible individual’s weight, 

11 health status, or achievement of perform12 ance goals; or 

13 ‘‘(iii) fails to comply with additional 

14 standards established by the Secretary. 

15 ‘‘(3) ADMINISTRATIVE LOCATION DEFINED.—In 

16 this subsection, the term ‘administrative location’ 

17 means a physical location in which a diabetes pre18 vention program supplier is the primary operator of 

19 such location or the location from which the diabetes 

20 prevention program supplier’s business is run in the 

21 case of an online or combination program, and 

22 where in-person diabetes prevention program serv23 ices may or may not be furnished.’’. 

24 (c) PAYMENT FOR DIABETES PREVENTION PROGRAM

25 SERVICES.—Section 1834 of the Social Security Act (42 


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1 U.S.C. 1395m) is amended by adding at the end the fol2 lowing subsection: 

3 ‘‘(aa) PAYMENT FOR DIABETES PREVENTION PRO4 GRAM SERVICES.— 

5 ‘‘(1) IN GENERAL.—The Secretary shall estab6 lish an appropriate payment structure under which 

7 the Secretary shall make payments to a diabetes 

8 prevention program supplier for diabetes prevention 

9 program services furnished to an eligible individual 

10 (as defined in section 1861(nnn)(2)). 

11 ‘‘(2) ANNUAL UPDATE.—The Secretary shall 

12 update the payment structure under this subsection 

13 annually by the percentage increase in the Consumer 

14 Price Index for all urban consumers (all items; 

15 United States city average) for the 12-month period 

16 ending with June of the preceding year. 

17 ‘‘(3) TERMINATION OF PARTICIPATION.— 

18 ‘‘(A) IN GENERAL.—A diabetes prevention 

19 program supplier may terminate the participa20 tion of an individual participating in the diabe21 tes prevention program if the individual is no 

22 longer an eligible individual (as defined in sec23 tion 1862(nnn)(2)). 

24 ‘‘(B) DOCUMENTATION SUPPORTING TER25 MINATION.—In the case of a diabetes prevenVerDate Sep 11 2014 04:15 Apr 13, 2024 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H7856.IH H7856

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1 tion program supplier that terminates the par2 ticipation of an individual participating in the 

3 diabetes prevention program, such supplier shall 

4 maintain records supporting such termination, 

5 including the date of the termination, the rea6 son for the termination, the details of any inci7 dents leading to such termination, any remedi8 ation efforts taken by such supplier, and any 

9 final actions taken by such supplier. 

10 ‘‘(4) CONTINUATION OF MEDICARE DIABETES

11 PREVENTION PROGRAM EXPANDED MODEL STAND12 ARDS.—Except as specified otherwise in this Act, 

13 the Secretary shall extend the standards of the 

14 Medicare Diabetes Prevention Program Expanded 

15 Model (in effect as of the date of enactment of the 

16 PREVENT DIABETES Act) to govern the diabetes 

17 prevention program. 

18 ‘‘(5) DIABETES PREVENTION PROGRAM.—In 

19 this subsection, the term ‘diabetes prevention pro20 gram’ means the payment structure described in this 

21 subsection.’’. 

22 SEC. 3. SUNSET OF MDPP EXPANDED MODEL. 

23 No payment shall be made for services furnished 

24 under the Medicare Diabetes Prevention Program Ex25 panded Model conducted under section 1115A of the SoVerDate Sep 11 2014 04:15 Apr 13, 2024 Jkt 049200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H7856.IH H7856

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1 cial Security Act (42 U.S.C. 1315a) after January 1, 

2 2025. 

3 SEC. 4. UPDATE TO REGULATIONS. 

4 Not later than November 30, 2024, the Secretary of 

5 Health and Human Services shall update the regulations 

6 in sections 410.79, 414.84, 424.200, and 424.205 of title 

7 42, Code of Federal Regulations, and any other relevant 

8 regulations, in accordance with sections 2 and 3 of this 

9 Act. 

10 SEC. 5. REPORT. 

11 Not later than January 1, 2028, the Secretary of 

12 Health and Human Services shall submit to Congress a 

13 report on the diabetes prevention program. Such report 

14 shall include a description of the impact of such program 

15 on— 

16 (1) participation of eligible individuals and dia17 betes prevention program suppliers in the diabetes 

18 prevention program as compared to the Medicare 

19 Diabetes Prevention Program Expanded Model; 

20 (2) weight loss among eligible individuals; 

21 (3) health outcomes of eligible individuals; and 

22 (4) diagnoses and costs relating to type 2 dia23 betes for eligible individuals who have received diaVerDate Sep 11 2014 04:15 Apr 13, 2024 Jkt 049200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H7856.IH H7856

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1 betes prevention plan services versus those who have 

2 not. 

Æ 


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