II 

118TH CONGRESS 

1ST SESSION S. 3233 

To amend title XVIII of the Social Security Act to reduce the occurrence 

of diabetes in Medicare beneficiaries by extending coverage under Medicare for medical nutrition therapy services to such beneficiaries with 

pre-diabetes or with risk factors for developing type 2 diabetes. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 7, 2023 

Mr. PETERS (for himself and Mrs. CAPITO) 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 reduce 

the occurrence of diabetes in Medicare beneficiaries by 

extending coverage under Medicare for medical nutrition 

therapy services to such beneficiaries with pre-diabetes 

or with risk factors for developing type 2 diabetes. 

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 ‘‘Preventing Diabetes 

5 in Medicare Act of 2023’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) According to the Centers for Disease Con2 trol and Prevention, there are more than 96,000,000 

3 adults with pre-diabetes in the United States. The 

4 Centers estimates that 27 percent of adults who are 

5 65 years of age or older have pre-diabetes. More 

6 than 80 percent of adults with pre-diabetes do not 

7 know they have it. 

8 (2) For a significant number of people with 

9 pre-diabetes, early intervention can reverse elevated 

10 blood glucose levels to normal range and prevent di11 abetes and its complications completely or can sig12 nificantly delay its onset. According to the Institute 

13 for Alternative Futures, if 50 percent of adults with 

14 pre-diabetes were able to successfully make lifestyle 

15 changes proven to prevent or delay diabetes, then by 

16 2025 approximately 4,700,000 new cases of diabetes 

17 could be prevented at a cost savings of $300 billion. 

18 (3) Preventing diabetes and its complications 

19 can save money and lives. The average annual cost 

20 to treat someone with diabetes is $16,752, which is 

21 2.3 times higher than average costs for someone who 

22 does not have diabetes. The United States spends 

23 $327 billion per year on costs associated with diabe24 tes, with government insurance including Medicare 

covering over 2 25 ⁄3 of these costs. 


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1 (4) Diabetes is unique because its complications 

2 and their associated health care costs are often pre3 ventable with currently available medical treatment 

4 and lifestyle changes. 

5 (5) According to the American Journal of Clin6 ical Nutrition, pre-diabetes medical nutrition therapy 

7 provided by a dietitian, such as that found in life8 style interventions, has the potential to improve gly9 cemic control and prevent progression of type 2 dia10 betes. In addition, an independent systematic review 

11 of diabetes prevention using nutrition therapy con12 ducted in Europe found that individuals who re13 ceived the lifestyle interventions had a 47-percent re14 duced risk of developing type 2 diabetes. 

15 (6) The Medicare program currently provides 

16 coverage for screening and identifying beneficiaries 

17 with pre-diabetes but does not provide adequate 

18 services to such beneficiaries to help them prevent or 

19 delay the onset of diabetes. 

20 (7) According to the Office of Minority Health 

21 and Health Equity within the Department of Health 

22 and Human Services, diabetes disproportionately af23 fects racial and ethnic minority populations. Com24 pared with White adults, African-American adults 

25 are 60 percent more likely to be diagnosed with diaVerDate Sep 11 2014 22:50 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3233.IS S3233

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1 betes by a physician and are twice as likely to die 

2 from diabetes. 

3 SEC. 3. MEDICARE COVERAGE OF MEDICAL NUTRITION 

4 THERAPY SERVICES FOR PEOPLE WITH PRE5 DIABETES AND RISK FACTORS FOR DEVEL6 OPING TYPE 2 DIABETES. 

7 (a) IN GENERAL.—Section 1861 of the Social Secu8 rity Act (42 U.S.C. 1395x) is amended— 

9 (1) in subsection (s)(2)(V), by striking ‘‘a bene10 ficiary with diabetes or a renal disease’’ and insert11 ing ‘‘an individual with diabetes, pre-diabetes (as de12 fined in subsection (yy)(4)), or a renal disease, or an 

13 individual at risk for diabetes (as defined in sub14 section (yy)(2)),’’ in the matter preceding clause (i); 

15 and 

16 (2) in subsection (yy)— 

17 (A) in the heading, by adding ‘‘; Pre-Dia18 betes’’ at the end; and 

19 (B) by adding at the end the following new 

20 paragraph: 

21 ‘‘(4) The term ‘pre-diabetes’ means a condition of im22 paired fasting glucose or impaired glucose tolerance identi23 fied by a blood glucose level that is higher than normal, 

24 but not so high as to indicate actual diabetes.’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply with respect to services furnished 

3 on or after January 1, 2025. 

Æ 


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