I 

108TH CONGRESS 

1ST SESSION H. R. 3194

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. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 25, 2003

Mr. WELDON of Pennsylvania (for himself and Ms. DEGETTE) 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 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.

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

2 This Act may be cited as the ‘‘Diabetes Self-Manage3 ment Training Act of 2003’’. 

4 SEC. 2. FINDINGS. 

5 Congress makes the following findings: 

6 (1) Diabetes is the fifth leading cause of death 

7 in the United States. Over 17,000,000 Americans 

8 (6.2 percent of the population) currently are living 

9 with diabetes, a number that is estimated to increase 

10 to 29,000,000 by the year 2050. In 2002, diabetes 

11 accounted for $132,000,000,000 in direct and indi12 rect health care costs. Diabetes is widely recognized 

13 as one of the top public health threats facing our na14 tion today. 

15 (2) Diabetes can occur in 2 forms—type 1 dia16 betes is caused by the body’s inability to produce in17 sulin, a hormone that allows glucose or sugar to 

18 enter and fuel cells, and type 2 diabetes, which oc19 curs when the body fails to make enough insulin, or 

20 fails to properly use it. People with type 1 diabetes 

21 are required to take daily insulin injections to stay 

22 alive. While some people with type 2 diabetes need 

23 insulin shots, others with type 2 diabetes can control 

24 their diabetes through healthy diet, nutrition, and 

25 lifestyle changes. Type 2 diabetes accounts for up to 

26 95 percent of all diabetes cases affecting 8 percent 
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1 of the population age 20 and older. The prevalence 

2 of type 2 diabetes has tripled in the last 30 years, 

3 with much of that increase due to an upsurge in 

4 obesity. 

5 (3) The Diabetes Prevention Program study in 

6 2002 found that participants (all of whom were at 

7 increased risk of developing type 2 diabetes) who 

8 made lifestyle changes reduced their risk of getting 

9 type 2 diabetes by 58 percent. 

10 (4) Diabetes self-management training (DSMT) 

11 also called diabetes education, provides knowledge 

12 and skill training to patients with diabetes, helping 

13 them identify barriers, facilitate problem solving, 

14 and develop coping skills to effectively manage their 

15 diabetes. Unlike many other diseases, diabetes re16 quires constant vigilance on the part of the patient 

17 and demands far more than just taking pills or insu18 lin shots. A certified diabetes educator is a health 

19 care professional—often a nurse, dietitian, or phar20 macist, who specializes in helping people with diabe21 tes develop the self-management skills needed to 

22 stay healthy and avoid costly acute complications 

23 and emergency care, as well as debilitating sec24 ondary conditions caused by diabetes. 
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1 (5) There are currently over 13,000 diabetes 

2 educators in the United States, most of whom are 

3 certified diabetes educators (CDEs). To earn a CDE 

4 designation, a health care professional must be li5 censed or have received a masters degree in a rel6 evant public health concentration, have completed 2 

7 years of professional practice experience in diabetes 

8 self-management training, and have provided a min9 imum of 1000 hours of diabetes self-management 

10 training. Many other health care professionals that 

11 are able to bill for diabetes education through the 

12 medicare program have far less experience or ability 

13 to provide the skilled expertise to help people with 

14 diabetes self-manage the disease. CDEs are the best 

15 trained health care professionals to provide DSMT 

16 and their experience and background is in stark con17 trast to the 12 hours of continuing education that 

18 non-physician health care providers or suppliers 

19 must obtain every 2 years, as required by the Cen20 ters for Medicare & Medicaid Services. 

21 (6) CDEs represent the only group of health 

22 care professionals who provide diabetes self-manage23 ment training that have not been recognized as 

24 health care providers and are therefore precluded 

25 from directly billing the medicare program for 
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1 DSMT. Adding CDEs as providers to that program 

2 would give diabetes patients access to the care they 

3 need. 

4 SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU5 CATORS AS MEDICARE PROVIDERS FOR PUR6 POSES OF DIABETES OUTPATIENT SELF-MAN7 AGEMENT TRAINING SERVICES. 

8 (a) IN GENERAL.—Section 1861(qq) of the Social Se9 curity Act (42 U.S.C. 1395x(qq)) is amended—

10 (1) in paragraph (2)—

11 (A) in subparagraph (A), by inserting 

12 ‘‘and includes a certified diabetes educator (as 

13 defined in paragraph (3)) who is recognized by 

14 the National Certification Board of Diabetes 

15 Educators and is working within a recognized 

16 diabetes education program’’ before the semi17 colon at the end; and 

18 (B) in subparagraph (B), by inserting be19 fore the period at the end the following: ‘‘or is 

20 a certified diabetes educator (as so defined) 

21 who is recognized by the National Certification 

22 Board of Diabetes Educators and is working 

23 within a recognized diabetes education pro24 gram’’; and 

25 (2) by adding at the end the following: 
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1 ‘‘(3) For purposes of paragraph (2), the term ‘cer2 tified diabetes educator’ means an individual who—

3 ‘‘(A) is a health care professional who special4 izes in helping individuals with diabetes develop the 

5 self-management skills needed to overcome the daily 

6 challenges and problems caused by the disease; 

7 ‘‘(B) is a licensed nurse, occupational therapist, 

8 optometrist, pharmacist, physical therapist, physi9 cian assistant, podiatrist, a registered dietitian, or 

10 has an advanced degree in nutrition, social work, 

11 clinical psychology, exercise physiology, health edu12 cation or a related public health area such as health 

13 education, health promotion, health and social be14 havior or health communication; 

15 ‘‘(C) has at least 2 years of professional prac16 tice experience in diabetes self-management training; 

17 ‘‘(D) has provided a minimum of 1000 hours of 

18 diabetes self-management training to patients within 

19 the most recent 5 years; and 

20 ‘‘(E) has passed a certification exam approved 

21 by the National Certification Board of Diabetes 

22 Educators.’’. 

23 (b) GAO STUDY AND REPORT.—

24 (1) STUDY.—The Comptroller General of the 

25 United States shall conduct a study to determine the 
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1 barriers, if any, that exist in rural areas to success2 fully becoming a recognized diabetes education pro3 gram, including the difficulty of rural health care 

4 professionals in becoming certified diabetes edu5 cators (as defined in section 1861(qq)(3) of the So6 cial Security Act (as added by subsection (a)(2))), 

7 and whether individuals with diabetes who live in 

8 rural areas have barriers to accessing diabetes self9 management training. 

10 (2) REPORT.—Not later than 1 year after the 

11 date of enactment of this Act, the Comptroller Gen12 eral of the United States shall submit a report to 

13 Congress regarding the study conducted under para14 graph (2). 

15 (c) EFFECTIVE DATE.—The amendments made by 

16 subsection (a) apply to diabetes outpatient self-manage17 ment training services furnished on or after October 1, 

18 2003.

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