II

104TH CONGRESS

1ST SESSION S. 491

To amend title XVIII of the Social Security Act to provide coverage of

outpatient self-management training services under part B of the medicare program for individuals with diabetes.

IN THE SENATE OF THE UNITED STATES

MARCH 2 (legislative day, FEBRUARY 22), 1995

Mr. BREAUX (for himself, Mr. HOLLINGS, Mr. INOUYE, Mr. COCHRAN, and

Mr. CHAFEE) 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 provide

coverage of outpatient self-management training services

under part B of the medicare program for individuals

with 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 ‘‘Medicare Diabetes

5 Outpatient Self-Management Training Act of 1995’’.
2

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1 SEC. 2. MEDICARE COVERAGE OF DIABETES OUTPATIENT

2 SELF-MANAGEMENT TRAINING SERVICES.

3 (a) IN GENERAL.—Section 1861(s)(2) of the Social

4 Security Act (42 U.S.C. 1395x(s)(2)) is amended—

5 (1) by striking ‘‘and’’ at the end of subpara6 graph (O) (as redesignated by section

7 147(f)(6)(B)(iii)(II) of the Social Security Act

8 Amendments of 1994 (Pub. Law 103-432)); and

9 (2) by inserting after subparagraph (O) the fol10 lowing new subparagraph:

11 ‘‘(P) diabetes outpatient self-management train12 ing services (as defined in subsection (oo)); and.’’.

13 (b) DEFINITION.—Section 1861 of the Social Secu14 rity Act (42 U.S.C. 1395x) is amended by adding at the

15 end the following new subsection:

16 ‘‘Diabetes Outpatient Self-Management Training Services

17 ‘‘(oo)(1) The term ‘diabetes outpatient self-manage18 ment training services’ means educational and training

19 services furnished to an individual with diabetes by or

20 under arrangements with a certified provider (as described

21 in paragraph (2)(A)) if—

22 ‘‘(A) the services are furnished in an outpatient

23 setting by an individual or entity meeting the quality

24 standards described in paragraph (2)(B); and

25 ‘‘(B) the physician who is managing the individ26 ual’s diabetic condition certifies that the services are
3

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1 needed under a comprehensive plan of care related

2 to the individual’s diabetic condition to provide the

3 individual with necessary skills and knowledge (in4 cluding skills related to the self-administration of

5 injectable drugs) to participate in the management

6 of the individual’s condition.

7 ‘‘(2) In paragraph (1)—

8 ‘‘(A) a ‘certified provider’ is an individual or

9 entity that, in addition to furnishing diabetes out10 patient self-management training services, provides

11 other items or services for which payment may be

12 made under this title; and

13 ‘‘(B) an individual or entity meets the quality

14 standards described in this paragraph if the individ15 ual or entity—

16 ‘‘(i) meets quality standards established by

17 the Secretary;

18 ‘‘(ii) meets applicable standards developed

19 by the National Diabetes Advisory Board, in20 cluding any revision of such standards by the

21 organizations that participated in the original

22 development of the applicable standards; or

23 ‘‘(iii) is recognized by the American Diabe24 tes Association as being qualified to furnish the

25 services.’’.
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1 (c) CONSULTATION WITH ORGANIZATIONS IN ESTAB2 LISHING PAYMENT AMOUNTS FOR SERVICES PROVIDED

3 BY PHYSICIANS.—In establishing payment amounts under

4 section 1848(a) of the Social Security Act for physicians’

5 services consisting of diabetes outpatient self-management

6 training services, the Secretary of Health and Human

7 Services shall consult with appropriate organizations, in8 cluding the American Diabetes Association, in determining

9 the relative value for such services under section

10 1848(c)(2) of such Act.

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

12 this section shall apply to services furnished on or after

13 January 1, 1996.

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