I 

108TH CONGRESS 

1ST SESSION H. R. 3203

To amend the Public Health Service Act to authorize grants for education, 

screening, and treatment with the goal of preventing diabetic foot complications and lower extremity amputations, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 30, 2003

Mr. BAKER (for himself, Mr. MCCRERY, Mr. JOHN, Mr. NETHERCUTT, Mr. 

JEFFERSON, Mrs. MCCARTHY of New York, and Mr. FALEOMAVAEGA) 

introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL

To amend the Public Health Service Act to authorize grants 

for education, screening, and treatment with the goal 

of preventing diabetic foot complications and lower extremity amputations, 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 ‘‘Diabetic Foot Com5 plication and Lower Extremity Amputation Reduction Act 

6 of 2003’’. 
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1 SEC. 2. FINDINGS. 

2 The Congress finds the following: 

3 (1) It is estimated that there are 17,000,000 

4 patients with diabetes in the United States and that 

5 diabetes costs the United States $132,000,000,000 

6 each year. 

7 (2) There has been a 61 percent increase in the 

8 number of Americans with diabetes since 1990. 

9 (3) Fifteen percent of people with diabetes will 

10 experience a foot ulcer, and between 14 and 24 per11 cent of those with a foot ulcer will require an ampu12 tation. 

13 (4) The increased incidence of diabetes has re14 sulted in more lower extremity amputations. From 

15 1980 to 1996, the number of diabetes-related hos16 pital discharges with lower extremity amputations 

17 increased from 36,000 to 86,000 per year. 

18 (5) The Medicare costs for diabetes patients 

19 with foot ulcers is 3 times higher than for diabetes 

20 patients in general, and inpatient care accounts for 

21 74 percent of diabetic ulcer-related costs. Therefore, 

22 cost effective ulcer prevention and treatment inter23 ventions will reduce Medicare costs. 

24 (6) Lower extremity amputations are dev25 astating to the patient, and with an average cost of 
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1 $60,000, these procedures are a costly burden on 

2 the health system. 

3 (7) Research shows that a multidisciplinary ap4 proach, including preventive strategies, patient and 

5 staff education, and treatment of foot ulcers, has 

6 been reported to reduce amputation rates by more 

7 than 50 percent at a fraction of the cost. 

8 SEC. 3. GRANTS FOR EDUCATION, SCREENING, AND TREAT9 MENT REGARDING DIABETIC FOOT COM10 PLICATIONS. 

11 Title III of the Public Health Service Act (42 U.S.C. 

12 241 et seq.) is amended by inserting after section 330K 

13 the following: 

14 ‘‘SEC. 330L. GRANTS FOR EDUCATION, SCREENING, AND 

15 TREATMENT REGARDING DIABETIC FOOT 

16 COMPLICATIONS. 

17 ‘‘(a) GRANTS.—Subject to subsection (b), the Sec18 retary shall award grants to eligible entities for the fol19 lowing: 

20 ‘‘(1) Providing a high-risk, underserved popu21 lation with screening, education, and evidence-based 

22 medical treatment regarding diabetic foot complica23 tions that may lead to lower extremity amputations. 

24 ‘‘(2) Evaluating the quality, cost effectiveness, 

25 parity, and patient satisfaction of medical interven-
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1 tions in the prevention of diabetic foot complications 

2 and lower extremity amputations. 

3 ‘‘(b) RESTRICTION.—A grant under this section may 

4 be used to pay for a treatment only if the treatment is 

5 preventive in nature or is part of comprehensive outpatient 

6 care. 

7 ‘‘(c) ELIGIBLE ENTITIES.—For purposes of this sec8 tion, the term ‘eligible entity’ means a multidisciplinary 

9 health care program, which may be university-based, that 

10 demonstrates to the Secretary’s satisfaction the following: 

11 ‘‘(1) An ability to provide high-quality, cost-ef12 fective, and accessible treatment to a patient popu13 lation that has a high incidence of diabetes relative 

14 to the national average and a general inability to ac15 cess diabetic foot treatment programs. 

16 ‘‘(2) An ability to successfully educate patients 

17 and health care providers about preventive health 

18 care measures and treatment methods for diabetic 

19 foot complications. 

20 ‘‘(3) An ability to analyze and compile the re21 sults of research on diabetic foot complications and 

22 conduct additional research on diabetic foot com23 plications. 

24 ‘‘(d) CRITERIA.—The Secretary, in consultation with 

25 appropriate professional organizations, shall develop cri-
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1 teria for carrying out the grant program under this section 

2 and for collecting data to evaluate the effectiveness of the 

3 grant program. These criteria shall ensure the following: 

4 ‘‘(1) The establishment of an authoritative, col5 laborative, multi-center study on the impact of com6 prehensive prevention and treatment of diabetic foot 

7 complications in high-risk, underserved populations, 

8 upon which future determinations can be based. 

9 ‘‘(2) The establishment, in coordination with 

10 grant recipients, of evidence-based guidelines and 

11 standardized measurement outcomes that may be 

12 used to evaluate the overall results of projects under 

13 this section. 

14 ‘‘(3) The provision to grant recipients of the 

15 necessary resources to develop programs that effec16 tively treat patients. 

17 ‘‘(e) APPLICATION.—To seek a grant under this sec18 tion, an eligible entity must submit an application to the 

19 Secretary in such form, in such manner, and containing 

20 such information as the Secretary may require. 

21 ‘‘(f) EVALUATIONS.—The Secretary may not award 

22 a grant to an eligible entity under this section unless the 

23 entity agrees to submit to the Secretary a yearly evalua24 tion of the entity’s operations and activities carried out 

25 under the grant. 
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1 ‘‘(g) STUDY; REPORT.—Annually, the Secretary—

2 ‘‘(1) shall conduct an authoritative study on the 

3 results of grants under this section, for the purpose 

4 of better informing future determinations regarding 

5 education, screening, and treatment of diabetic foot 

6 complications; and 

7 ‘‘(2) shall submit a report on the findings and 

8 conclusions of the study to the Congress. 

9 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the 

10 purpose of carrying out this section, there are authorized 

11 to be appropriated $25,000,000 for fiscal year 2004 and 

12 such sums as may be necessary for each of fiscal years 

13 2005 through 2008.’’.

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