I

104TH CONGRESS

1ST SESSION H. R. 1073

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

of diabetes outpatient self-management training services under part B

of the medicare program.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 28, 1995

Ms. FURSE (for herself, Mr. GEJDENSON, Mr. NETHERCUTT, and Mr. LIPINSKI) introduced the following bill; which was referred to the Committee

on 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 diabetes outpatient self-management

training services under part B of the medicare program.

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

3 SECTION 1. MEDICARE COVERAGE OF DIABETES OUT4 PATIENT SELF-MANAGEMENT TRAINING

5 SERVICES.

6 (a) IN GENERAL.—Section 1861(s)(2) of the Social

7 Security Act (42 U.S.C. 1395x(s)(2)), as amended by sec-
2

•HR 1073 IH

1 tion 147(f)(6)(B) of the Social Security Act Amendments

2 of 1994, is amended—

3 (1) by striking ‘‘and’’ at the end of subpara4 graph (N);

5 (2) by striking ‘‘and’’ at the end of subpara6 graph (O); and

7 (3) by inserting after subparagraph (O) the fol8 lowing new subparagraph:

9 ‘‘(P) diabetes outpatient self-management train10 ing services (as defined in subsection (oo)); and’’.

11 (b) DEFINITION.—Section 1861 of such Act (42

12 U.S.C. 1395x) is amended by adding at the end the follow13 ing new subsection:

14 ‘‘DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING

15 SERVICES

16 ‘‘(oo)(1) The term ‘diabetes outpatient self-manage17 ment training services’ means educational and training

18 services furnished to an individual with diabetes by or

19 under arrangements with a certified provider (as described

20 in paragraph (2)(A)) in an outpatient setting by an indi21 vidual or entity who meets the quality standards described

22 in paragraph (2)(B), but only if the physician who is man23 aging the individual’s diabetic condition certifies that such

24 services are needed under a comprehensive plan of care

25 related to the individual’s diabetic condition to provide the

26 individual with necessary skills and knowledge (including
3

•HR 1073 IH

1 skills related to the self-administration of injectable drugs)

2 to participate in the management of the individual’s condi3 tion.

4 ‘‘(2) In paragraph (1)—

5 ‘‘(A) a ‘certified provider’ is an individual or

6 entity that, in addition to providing diabetes out7 patient self-management training services, provides

8 other items or services for which payment may be

9 made under this title; and

10 ‘‘(B) an individual or entity meets the quality

11 standards described in this paragraph if the individ12 ual or entity meets quality standards established by

13 the Secretary, except that the individual or entity

14 shall be deemed to have met such standards if the

15 individual or entity meets applicable standards origi16 nally established by the National Diabetes Advisory

17 Board and subsequently revised by organizations

18 who participated in the establishment of standards

19 by such Board, or is recognized by the American Di20 abetes Association as meeting standards for furnish21 ing the services.’’.

22 (c) CONSULTATION WITH ORGANIZATIONS IN ESTAB23 LISHING PAYMENT AMOUNTS FOR SERVICES PROVIDED

24 BY PHYSICIANS.—In establishing payment amounts under

25 section 1848(a) of the Social Security Act for physicians’
4

•HR 1073 IH

1 services consisting of diabetes outpatient self-management

2 training services, the Secretary of Health and Human

3 Services shall consult with appropriate organizations, in4 cluding the American Diabetes Association, in determining

5 the relative value for such services under section

6 1848(c)(2) of such Act.

7 (d) EFFECTIVE DATE.—The amendments made by

8 this section shall apply to services furnished on or after

9 January 1, 1996.

Æ