I

103D CONGRESS

1ST SESSION H. R. 1194

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

self-management training services under part B of the medicare program

for individuals with diabetes.

IN THE HOUSE OF REPRESENTATIVES

MARCH 3, 1993

Mr. KOPETSKI introduced the following bill; which was referred jointly to the

Committees on Ways and Means and Energy and Commerce

A BILL

To amend title XVIII of the Social Security Act to provide

coverage of 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 Services Coverage

6 Act of 1993’’.
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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);

7 (2) by adding ‘‘and’’ at the end of subpara8 graph (P); and

9 (3) by adding at the end the following new sub10 paragraph:

11 ‘‘(Q) diabetes outpatient self-management

12 training services (as defined in subsection (oo)).’’.

13 (b) DEFINITION.—Section 1861 (42 U.S.C. 1395x)

14 is amended by adding at the end the following new sub15 section:

16 ‘‘DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING

17 SERVICES

18 ‘‘(oo)(1) The term ‘diabetes outpatient self-manage19 ment training services’ means educational and training

20 services furnished to an individual with diabetes by or

21 under arrangements with a certified provider (as described

22 in paragraph (2)(A)) in an outpatient setting by an indi23 vidual or entity who meets the quality standards described

24 in paragraph (2)(B), but only if the physician who is man25 aging the individual’s diabetic condition certifies that such

26 services are needed under a comprehensive plan of care
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1 related to the individual’s diabetic condition to provide the

2 individual with necessary skills and knowledge (including

3 skills related to the self-administration of injectable drugs)

4 to participate in the management of the individual’s condi5 tion.

6 ‘‘(2) In paragraph (1)—

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

8 entity that, in addition to providing diabetes out9 patient self-management training services, provides

10 other items or services for which payment may be

11 made under this title; and

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

13 standards described in this paragraph if the individ14 ual or entity meets quality standards established by

15 the Secretary, except that the individual or entity

16 shall be deemed to have met such standards if the

17 individual or entity meets applicable standards es18 tablished by the National Diabetes Advisory Board

19 or is certified by the American Diabetes Association

20 as qualified to furnish the services.’’.

21 (c) CONSULTATION WITH ORGANIZATIONS IN ESTAB22 LISHING PAYMENT AMOUNTS FOR SERVICES PROVIDED

23 BY PHYSICIANS.—In establishing payment amounts under

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

25 services consisting of diabetes outpatient self-management
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1 training services, the Secretary of Health and Human

2 Services shall consult with appropriate organizations, in3 cluding the American Diabetes Association, in determining

4 the relative value for such services under section

5 1848(c)(2) of such Act.

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

7 this section shall apply to services furnished on or after

8 January 1, 1994.

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