II 

112TH CONGRESS 

1ST SESSION S. 1468 

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

self-management training by authorizing certified diabetes educators to 

provide diabetes self-management training services, including as part 

of telehealth services, under part B of the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 2, 2011 

Mrs. SHAHEEN (for herself and Mr. TESTER) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to improve 

access to diabetes self-management training by authorizing certified diabetes educators to provide diabetes selfmanagement training services, including as part of telehealth 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. SHORT TITLE. 

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

5 Self-Management Training Act of 2011’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) Diabetes self-management training, also 

2 called diabetes education, provides critical knowledge 

3 and skills training to patients with diabetes, helping 

4 them manage medications, address nutritional 

5 issues, facilitate diabetes related problem solving, 

6 and make other critical lifestyle changes to effec7 tively manage their diabetes. 

8 (2) A certified diabetes educator is a State li9 censed or registered health care professional who 

10 specializes in helping people with diabetes develop 

11 the self-management skills needed to stay healthy 

12 and avoid costly acute complications and emergency 

13 care, as well as debilitating secondary conditions 

14 caused by diabetes. 

15 (3) Diabetes self-management training has been 

16 proven effective in helping to reduce the risks and 

17 complications of diabetes and is a vital component of 

18 an overall diabetes treatment regimen. Patients 

19 under the care of a certified diabetes educator are 

20 better able to control their diabetes and improve 

21 their health status. 

22 (4) Lifestyle changes, such as those taught by 

23 certified diabetes educators, directly contribute to 

24 better glycemic control and reduced complications 

25 from diabetes. Evidence shows that the potential for 


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1 prevention of the most serious medical complications 

2 caused by diabetes to be as high as 90 percent 

3 (blindness), 85 percent (amputations), and 50 per4 cent (heart disease and stroke) with proper medical 

5 treatment and active self-management. 

6 (5) Despite its effectiveness in reducing diabe7 tes related complications and associated costs, diabe8 tes self-management training has been recognized by 

9 policymakers as an underutilized Medicare benefit. 

10 Enhancing access to diabetes self-management train11 ing programs that are taught by Certified Diabetes 

12 Educators is an important public policy goal that 

13 can help improve health outcomes, ensure quality, 

14 and reduce escalating diabetes-related health costs. 

15 SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU16 CATORS AS AUTHORIZED PROVIDERS OF 

17 MEDICARE DIABETES OUTPATIENT SELF18 MANAGEMENT TRAINING SERVICES. 

19 (a) IN GENERAL.—Section 1861(qq) of the Social Se20 curity Act (42 U.S.C. 1395x(qq)) is amended— 

21 (1) in paragraph (1), by striking ‘‘by a certified 

22 provider (as described in paragraph (2)(A)) in an 

23 outpatient setting’’ and inserting ‘‘in an outpatient 

24 setting by a certified diabetes educator (as defined 


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1 in paragraph (3)) or by a certified provider (as de2 scribed in paragraph (2)(A))’’; and 

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

4 paragraphs: 

5 ‘‘(3) For purposes of paragraph (1), the term ‘cer6 tified diabetes educator’ means an individual who— 

7 ‘‘(A) is licensed or registered by the State in 

8 which the services are performed as a health care 

9 professional; 

10 ‘‘(B) specializes in teaching individuals with di11 abetes to develop the necessary skills and knowledge 

12 to manage the individual’s diabetic condition; and 

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

14 recognized certifying body (as defined in paragraph 

15 (4)). 

16 ‘‘(4) For purposes of paragraph (3)(C), the term ‘rec17 ognized certifying body’ means a certifying body for diabe18 tes educators which is recognized by the Secretary as au19 thorized to grant certification of diabetes educators for 

20 purposes of this subsection pursuant to standards estab21 lished by the Secretary.’’. 

22 (b) TREATMENT AS A PRACTITIONER, INCLUDING

23 FOR TELEHEALTH SERVICES.—Section 1842(b)(18)(C) of 

24 the such Act (42 U.S.C. 1395u(b)(18)(C)) is amended by 

25 adding at the end the following new clause: 


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1 ‘‘(vii) A certified diabetes educator (as defined 

2 in section 1861(qq)(3)).’’. 

3 (c) GAO STUDY AND REPORT.— 

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

5 United States shall conduct a study to identify the 

6 barriers that exist for Medicare beneficiaries with di7 abetes in accessing diabetes self-management train8 ing services under the Medicare program, including 

9 economic and geographic barriers and availability of 

10 appropriate referrals and access to adequate and 

11 qualified providers. 

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

13 date of the enactment of this Act, the Comptroller 

14 General of the United States shall submit to Con15 gress a report on the study conducted under para16 graph (1). 

17 (d) AHRQ DEVELOPMENT OF RECOMMENDATIONS

18 FOR OUTREACH METHODS AND REPORT.— 

19 (1) DEVELOPMENT OF RECOMMENDATIONS.— 

20 The Director of the Agency for Healthcare Research 

21 and Quality shall, through use of a workshop and 

22 other appropriate means, develop a series of rec23 ommendations on effective outreach methods to edu24 cate primary care physicians and the public about 

25 the benefits of diabetes self-management training in 


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1 order to promote better health outcomes for patients 

2 with diabetes. 

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

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

5 the Agency for Healthcare Research and Quality 

6 shall submit to Congress a report on the rec7 ommendations developed under paragraph (1). 

8 (e) EFFECTIVE DATE.—The amendments made by 

9 this section shall apply to items and services furnished on 

10 or after January 1, 2013. 

Æ 


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