II 

113TH CONGRESS 

1ST SESSION S. 945 

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 

MAY 14, 2013 

Mrs. SHAHEEN (for herself, Ms. COLLINS, Mr. BEGICH, Mrs. HAGAN, and Mr. 

FRANKEN) 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 ‘‘Access to Quality Dia5 betes Education Act of 2013’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


tjames on DSK6SPTVN1PROD with BILLS
2 

•S 945 IS

1 (1) The Centers for Disease Control and Pre2 vention (hereinafter ‘‘CDC’’) report that nearly 

3 26,000,000 Americans have diabetes, in addition to 

4 an estimated 79,000,000 Americans who have 

5 prediabetes, an increase of 24,000,000 Americans 

6 with either diabetes or prediabetes since 2008. Peo7 ple with prediabetes are at increased risk of devel8 oping Type 2 diabetes or cardiovascular disease. 

9 (2) Diabetes impacts 8.3 percent of all Ameri10 cans and 11.3 percent of American adults. The CDC 

11 estimates that as many as 1 in 3 Americans will 

12 have diabetes by 2050 if current trends continue. 

13 (3) According to the American Diabetes Asso14 ciation, the total costs of diagnosed diabetes have 

15 risen to $245 billion in 2012 from $174 billion in 

16 2007, when the cost was last examined by the CDC. 

17 This figure represents a 41 percent increase over a 

18 five-year period. 

19 (4) One in 3 Medicare dollars is currently spent 

20 on people with diabetes. 

21 (5) There were 11.3 million diabetes related 

22 emergency room visits in 2008, compared with 9.5 

23 million in 2000, an increase of 11 percent. 

24 (6) According to the CDC, health care pro25 viders are finding statistically significant increases 


tjames on DSK6SPTVN1PROD with BILLS
3 

•S 945 IS

1 in the prevalence of Type 2 diabetes in children and 

2 adolescents. 

3 (7) Diabetes self-management training (herein4 after ‘‘DSMT’’), also called diabetes education, pro5 vides critical knowledge and skills training to pa6 tients with diabetes, helping them manage medica7 tions, address nutritional issues, facilitate diabetes8 related problem solving, and make other critical life9 style changes to effectively manage their diabetes. 

10 Evidence shows that individuals participating in 

11 DSMT programs are able to progress along the con12 tinuum necessary to make sustained behavioral 

13 changes in order to manage their diabetes. 

14 (8) A certified diabetes educator is a State li15 censed or registered health care professional who 

16 specializes in helping people with diabetes develop 

17 the self-management skills needed to stay healthy 

18 and avoid costly acute complications and emergency 

19 care, as well as debilitating secondary conditions 

20 caused by diabetes. 

21 (9) Diabetes self-management training has been 

22 proven effective in helping to reduce the risks and 

23 complications of diabetes and is a vital component of 

24 an overall diabetes treatment regimen. Patients who 

25 have received training from a certified diabetes eduVerDate Mar 15 2010 01:34 May 17, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S945.IS S945

tjames on DSK6SPTVN1PROD with BILLS
4 

•S 945 IS

1 cator are better able to implement the treatment 

2 plan received from a physician skilled in diabetes 

3 treatment. 

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

5 certified diabetes educators, directly contribute to 

6 better glycemic control and reduced complications 

7 from diabetes. Evidence shows that the potential for 

8 prevention of the most serious medical complications 

9 caused by diabetes to be as high as 90 percent 

10 (blindness), 85 percent (amputations), and 50 per11 cent (heart disease and stroke) with proper medical 

12 treatment and active self-management. 

13 (11) In recognition of the important role of 

14 DSMT programs, the CDC in 2012 awarded fund15 ing to expand the National Diabetes Prevention Pro16 gram to help prevent the onset of Type 2 diabetes 

17 for individuals at high risk. 

18 (12) The net savings to the Medicare program 

19 of ensuring that beneficiaries have access to quality 

20 DSMT is estimated to be $2,000,000,000 over 10 

21 years. 

22 (13) Despite its effectiveness in reducing diabe23 tes-related complications and associated costs, diabe24 tes self-management training has been recognized by 

25 the Centers for Medicare & Medicaid Services as an 


tjames on DSK6SPTVN1PROD with BILLS
5 

•S 945 IS

1 underutilized Medicare benefit, even after more than 

2 a decade of coverage. 

3 (14) Enhancing access to diabetes self-manage4 ment training programs that are certified as nec5 essary by the patient’s treating physician and taught 

6 by certified diabetes educators is an important pub7 lic policy goal that can help improve health out8 comes, ensure quality, and reduce escalating diabe9 tes-related health costs. 

10 SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU11 CATORS AS AUTHORIZED PROVIDERS OF 

12 MEDICARE DIABETES OUTPATIENT SELF13 MANAGEMENT TRAINING SERVICES. 

14 (a) IN GENERAL.—Section 1861(qq) of the Social Se15 curity Act (42 U.S.C. 1395x(qq)) is amended— 

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

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

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

19 setting by a certified diabetes educator (as defined 

20 in paragraph (3)) or by a certified provider (as de21 scribed in paragraph (2)(A))’’; and 

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

23 paragraphs: 

24 ‘‘(3) For purposes of paragraph (1), the term ‘cer25 tified diabetes educator’ means an individual— 


tjames on DSK6SPTVN1PROD with BILLS
6 

•S 945 IS

1 ‘‘(A) who is licensed or registered by the State 

2 in which the services are performed as a certified di3 abetes educator; or 

4 ‘‘(B) who— 

5 ‘‘(i) is licensed or registered by the State 

6 in which the services are performed as a health 

7 care professional; 

8 ‘‘(ii) specializes in teaching individuals 

9 with diabetes to develop the necessary skills and 

10 knowledge to manage the individual’s diabetic 

11 condition; and 

12 ‘‘(iii) is certified as a diabetes educator by 

13 a recognized certifying body (as defined in 

14 paragraph (4)). 

15 ‘‘(4) For purposes of paragraph (3)(B)(iii), the term 

16 ‘recognized certifying body’ means a certifying body for 

17 diabetes educators which is recognized by the Secretary 

18 as authorized to grant certification of diabetes educators 

19 for purposes of this subsection pursuant to standards es20 tablished by the Secretary.’’. 

21 (b) TREATMENT AS A PRACTITIONER, INCLUDING

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

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

24 adding at the end the following new clause: 


tjames on DSK6SPTVN1PROD with BILLS
7 

•S 945 IS

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 physicians and other health care providers as 

25 well as the public about the benefits of diabetes selfVerDate Mar 15 2010 01:34 May 17, 2013 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S945.IS S945

tjames on DSK6SPTVN1PROD with BILLS
8 

•S 945 IS

1 management training in order to promote better 

2 health outcomes for patients 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 

10 after the end of the 12-month period beginning on the date 

11 of the enactment of this Act. 

Æ 


tjames on DSK6SPTVN1PROD with BILLS