I 

111TH CONGRESS 

1ST SESSION H. R. 2425 

To amend title XVIII of the Social Security Act to improve access to diabetes 

self-management training by designating certain certified diabetes educators as certified providers for purposes of outpatient diabetes selfmanagement training services under part B of the Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 14, 2009 

Ms. DEGETTE (for herself, Mr. CASTLE, Mr. KIRK, Mr. BECERRA, and Mr. 

SPACE) 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 certain certified diabetes educators as certified 

providers for purposes of outpatient diabetes 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Medicare Diabetes 

3 Self-Management Training Act of 2009’’. 

4 SEC. 2. FINDINGS. 

5 Congress makes the following findings: 

6 (1) Diabetes is widely recognized as one of the 

7 top public health threats currently facing the United 

8 States. Approximately 24,000,000 people in the 

9 United States are currently living with diabetes, and 

10 another 57,000,000 people in the United States have 

11 pre-diabetes, dramatically raising their risk of devel12 oping diabetes, heart disease, and stroke. Three mil13 lion individuals with diagnosed diabetes receive no 

14 treatment for the disease, and only about 56 percent 

15 of those newly diagnosed with diabetes receive the 

16 type of diet and exercise counseling that are vital 

17 components of a diabetes self management training 

18 (DSMT) regimen. The number of Americans living 

19 with diabetes increased 50 percent between 1997– 

20 2004, and the Centers for Disease Control projects 

21 that the prevalence of diagnosed diabetes in the U.S. 

22 will increase 165 percent by 2050. 

23 (2) Diabetes costs the United States over $174 

24 billion annually, with $116 billion attributed to di25 rect medical costs associated with diabetes care, and 

26 $58 billion attributed to indirect costs associated 


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1 with lost productivity. Eighteen percent of all Medi2 care beneficiaries have diabetes, accounting for 32 

3 percent of Medicare spending. 

4 (3) Diabetes self-management training, also 

5 called diabetes education, provides critical knowledge 

6 and skills training to patients with diabetes, helping 

7 them identify barriers, facilitate problem solving, 

8 and develop coping skills to effectively manage their 

9 diabetes. A certified diabetes educator is a health 

10 care professional, often a nurse, dietitian, or phar11 macist, who specializes in helping people with diabe12 tes develop the self-management skills needed to 

13 stay healthy and avoid costly acute complications 

14 and emergency care, as well as debilitating sec15 ondary conditions caused by diabetes. 

16 (4) Diabetes self-management training has been 

17 proven effective in helping to reduce the risks and 

18 complications of diabetes. In 2002, the Diabetes 

19 Prevention Program study conducted by the Na20 tional Institutes of Health and the Centers for Dis21 ease Control and Prevention found that participants 

22 (all of whom were at increased risk of developing 

23 type 2 diabetes) who made lifestyle changes reduced 

24 their risk of getting type 2 diabetes by 58 percent. 

25 Lifestyle intervention worked in all of the groups but 


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1 it worked particularly well in people aged 60 and 

2 older, reducing the development of diabetes by 71 

3 percent. Similarly, studies have found that patients 

4 under the care of a certified diabetes educator are 

5 better able to control their diabetes and report im6 provement in their health status. 

7 (5) Lifestyle changes, such as those taught by 

8 certified diabetes educators, directly contribute to 

9 better glycemic control and reduced complications 

10 from diabetes. Evidence shows that the potential for 

11 prevention of the most serious medical complications 

12 caused by diabetes to be as high as 90 percent 

13 (blindness), 85 percent (amputations), and 50 per14 cent (heart disease and stroke) with proper medical 

15 treatment and active self-management. 

16 (6) There are currently more than 20,000 dia17 betes educators in the United States, most of whom 

18 are certified diabetes educators credentialed by the 

19 National Certification Board for Diabetes Edu20 cators. Eligibility for certification as a diabetes edu21 cator by the National Certification Board for Diabe22 tes Educators requires prerequisite qualifying pro23 fessional credentials in specific health care profes24 sions and professional practice experience that in25 cludes a minimum number of hours and years of exVerDate Nov 24 2008 23:40 May 15, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2425.IH H2425

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1 perience in diabetes self-management training. Dia2 betes educators certified by the National Certifi3 cation Board for Diabetes Educators must also pass 

4 a rigorous national examination and periodically 

5 renew their credentials. Diabetes educators certified 

6 by the National Certification Board for Diabetes 

7 Educators, and licensed by a State as a health pro8 fessional, are uniquely qualified to provide diabetes 

9 self-management training under the Medicare pro10 gram. 

11 (7) Enhancing access to diabetes self-manage12 ment training programs that are taught by Certified 

13 Diabetes Educators is an important public policy 

14 goal that can help improve health outcomes, ensure 

15 quality, and reduce escalating diabetes-related health 

16 costs. 

17 SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU18 CATORS AS CERTIFIED PROVIDERS FOR PUR19 POSES OF MEDICARE DIABETES OUTPATIENT 

20 SELF-MANAGEMENT TRAINING SERVICES. 

21 (a) IN GENERAL.—Section 1861(qq) of the Social Se22 curity Act (42 U.S.C. 1395x(qq)) is amended— 

23 (1) in paragraph (1), by inserting ‘‘or by a cer24 tified diabetes educator (as defined in paragraph 

25 (3))’’ after ‘‘paragraph (2)(B)’’; and 


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1 (2) by adding at the end the following new 

2 paragraphs: 

3 ‘‘(3) For purposes of paragraph (1), the term 

4 ‘certified diabetes educator’ means an individual 

5 who— 

6 ‘‘(A) is licensed or registered by the State 

7 in which the services are performed as a health 

8 care professional; 

9 ‘‘(B) specializes in teaching individuals 

10 with diabetes to develop the necessary skills and 

11 knowledge to manage the individual’s diabetic 

12 condition; and 

13 ‘‘(C) is certified as a diabetes educator by 

14 a recognized certifying body (as defined in 

15 paragraph (4)). 

16 ‘‘(4)(A) For purposes of paragraph (3)(B), the 

17 term ‘recognized certifying body’ means— 

18 ‘‘(i) the National Certification Board 

19 for Diabetes Educators, or 

20 ‘‘(ii) a certifying body for diabetes 

21 educators, which is recognized by the Sec22 retary as authorized to grant certification 

23 of diabetes educators for purposes of this 

24 subsection pursuant to standards estab25 lished by the Secretary, 


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1 if the Secretary determines such Board or body, 

2 respectively, meets the requirement of subpara3 graph (B). 

4 ‘‘(B) The National Certification Board for 

5 Diabetes Educators or a certifying body for dia6 betes educators meets the requirement of this 

7 subparagraph, with respect to the certification 

8 of an individual, if the Board or body, respec9 tively, is incorporated and registered to do busi10 ness in the United States and requires as a 

11 condition of such certification each of the fol12 lowing: 

13 ‘‘(i) The individual has a qualifying 

14 credential in a specified health care profes15 sion. 

16 ‘‘(ii) The individual has professional 

17 practice experience in diabetes self-man18 agement training that includes a minimum 

19 number of hours and years of experience in 

20 such training. 

21 ‘‘(iii) The individual has successfully 

22 completed a national certification examina23 tion offered by such entity. 


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1 ‘‘(iv) The individual periodically re2 news certification status following initial 

3 certification.’’. 

4 (b) GAO STUDY AND REPORT.— 

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

6 United States shall conduct a study to identify the 

7 barriers that exist for Medicare beneficiaries with di8 abetes in accessing diabetes self-management train9 ing services under the Medicare program, including 

10 economic and geographic barriers and availability of 

11 appropriate referrals and access to adequate and 

12 qualified providers. 

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

14 date of the enactment of this Act, the Comptroller 

15 General of the United States shall submit to Con16 gress a report on the study conducted under para17 graph (1). 

18 (c) AHRQ DEVELOPMENT OF RECOMMENDATIONS

19 FOR OUTREACH METHODS AND REPORT.— 

20 (1) DEVELOPMENT OF RECOMMENDATIONS.— 

21 The Director of the Agency for Healthcare Research 

22 and Quality shall, through use of a workshop and 

23 other appropriate means, develop a series of rec24 ommendations on effective outreach methods to edu25 cate primary care physicians and the public about 


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1 the benefits of diabetes self-management training in 

2 order to promote better health outcomes for patients 

3 with diabetes. 

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

5 date of the enactment of this Act, the Director of 

6 the Agency for Healthcare Research and Quality 

7 shall submit to Congress a report on the rec8 ommendations developed under paragraph (1). 

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

10 subsection (a) shall apply to diabetes outpatient self-man11 agement training services furnished on or after the first 

12 day of the first calendar year that is at least 6 months 

13 after the date of the enactment of this Act. 

Æ 


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