II 

114TH CONGRESS 

1ST SESSION S. 1131 

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

of diabetes among Medicare beneficiaries, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 29, 2015 

Mr. FRANKEN (for himself, Ms. COLLINS, Mr. GRASSLEY, Mr. BROWN, Mr. 

MENENDEZ, Mrs. SHAHEEN, Mr. SCHUMER, Ms. HIRONO, Mr. COONS, 

Ms. KLOBUCHAR, and Mrs. GILLIBRAND) 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 incidence of diabetes among Medicare beneficiaries, 

and for other purposes. 

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 Prevention Act of 2015’’. 

6 SEC. 2. DIABETES PREVENTION UNDER THE MEDICARE 

7 PROGRAM. 

8 (a) COVERAGE OF DIABETES PREVENTION PROGRAM

9 SERVICES.— 

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1 (1) COVERAGE OF SERVICES.— 

2 (A) IN GENERAL.—Section 1861(s)(2) of 

3 the Social Security Act (42 U.S.C. 1395x(s)(2)) 

4 is amended— 

5 (i) in subparagraph (EE), by striking 

6 ‘‘and’’ after the semicolon at the end; 

7 (ii) in subparagraph (FF), by insert8 ing ‘‘and’’ after the semicolon at the end; 

9 and 

10 (iii) by adding at the end the fol11 lowing new subparagraph: 

12 ‘‘(GG) items and services furnished under a di13 abetes prevention program (as defined in subsection 

14 (iii)(1)) to an eligible diabetes prevention program 

15 individual (as defined in subsection (iii)(2));’’. 

16 (B) DEFINITIONS.—Section 1861 of the 

17 Social Security Act (42 U.S.C. 1395x) is 

18 amended by adding at the end the following 

19 new subsection: 

20 ‘‘Diabetes Prevention Program; Eligible Diabetes Preven21 tion Program Individual; Qualified Diabetes Preven22 tion Program Provider 

23 ‘‘(iii)(1)(A) The term ‘diabetes prevention program’ 

24 means a program that— 

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1 ‘‘(i) meets the criteria described in subpara2 graph (B); and 

3 ‘‘(ii) is furnished by a qualified diabetes preven4 tion program provider (as defined in paragraph 

5 (3)(A)). 

6 ‘‘(B) The Secretary shall establish the criteria for a 

7 diabetes prevention program. Such criteria shall be in ac8 cordance with the standards under the National Diabetes 

9 Prevention Program, as established by the Centers for 

10 Disease Control and Prevention, and shall require that the 

11 program complies with the Federal regulations (con12 cerning the privacy of individually identifiable health in13 formation) promulgated under section 264(c) of the 

14 Health Insurance Portability and Accountability Act of 

15 1996. In establishing such criteria, the Secretary may also 

16 consider clinical evidence or other factors, such as the re17 sults of ongoing translational studies, as the Secretary de18 termines appropriate. 

19 ‘‘(C) Items and services furnished under a diabetes 

20 prevention program may, as determined appropriate by 

21 the Secretary, be furnished— 

22 ‘‘(i) in-person in a community setting; 

23 ‘‘(ii) virtually; or 

24 ‘‘(iii) via one or more proven distance-learning 

25 modalities. 

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1 ‘‘(D)(i) The Secretary shall establish procedures 

2 under which a qualified diabetes prevention program pro3 vider may contract with a diabetes prevention program de4 livery partner to furnish the items and services under a 

5 diabetes prevention program. Such items and services may 

6 be furnished in one or some combination of the settings 

7 described in clauses (i) through (iii) of subparagraph (C). 

8 ‘‘(ii) For purposes of this subsection, the term ‘diabe9 tes prevention program delivery partner’ means an entity, 

10 including non-profit organizations, public and private hos11 pitals, State and local departments of public health, Fed12 erally qualified health centers, and any other entity the 

13 Secretary determines appropriate, that meets criteria es14 tablished by the Secretary. Such criteria shall be in ac15 cordance with the standards under the National Diabetes 

16 Prevention Program, as established by the Centers for 

17 Disease Control and Prevention. In establishing such cri18 teria, the Secretary may also consider other factors or clin19 ical evidence as the Secretary determines appropriate. 

20 ‘‘(2)(A) The term ‘eligible diabetes prevention pro21 gram individual’ means an individual at risk for diabetes 

22 (as defined in subsection (yy)(2)) who would benefit from 

23 items and services under a diabetes prevention program, 

24 as determined based on criteria established by the Sec25 retary. 

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1 ‘‘(B) The criteria established under subparagraph 

2 (A) shall be in accordance with the standards under the 

3 National Diabetes Prevention Program, as established by 

4 the Centers for Disease Control and Prevention. In estab5 lishing such criteria, the Secretary may also consider other 

6 factors or clinical evidence as the Secretary determines ap7 propriate. 

8 ‘‘(3)(A)(i) The term ‘qualified diabetes prevention 

9 program provider’ means any entity, including a Federally 

10 qualified health center, that the Secretary determines— 

11 ‘‘(I) is appropriate to furnish items and services 

12 under a diabetes prevention program; and 

13 ‘‘(II) meets criteria established by the Sec14 retary, in consultation with the Centers for Disease 

15 Control and Prevention. 

16 ‘‘(ii) A qualified diabetes prevention program pro17 vider may be, as determined appropriate by the Secretary, 

18 a supplier (as defined in subsection (d)), a provider of 

19 services (as defined in subsection (u)), a health insurance 

20 or services company, a community-based organization, or 

21 any other appropriate entity. 

22 ‘‘(B) A qualified diabetes prevention program pro23 vider shall— 

24 ‘‘(i) furnish the items and services under the di25 abetes prevention program through a delivery partmstockstill on DSK4VPTVN1PROD with BILLS

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1 ner (pursuant to paragraph (1)(D)) unless no such 

2 delivery partner is available; 

3 ‘‘(ii) manage, track, and verify the outcomes of 

4 a diabetes prevention program (including attendance 

5 and observed weight loss of participating individuals) 

6 through defined systems which do not rely on data 

7 self-reported by participating individuals, including 

8 outcomes of programs furnished under contract with 

9 a diabetes prevention program delivery partner; 

10 ‘‘(iii) implement business processes to manage 

11 program workflow, such as eligibility, reporting, 

12 claims billing, class scheduling, and enrollment; 

13 ‘‘(iv) manage and verify billing accuracy and 

14 beneficiary eligibility (as described in paragraph 

15 (2)); 

16 ‘‘(v) comply with applicable laws and regula17 tions and ensure such compliance by a diabetes pre18 vention program delivery partner; 

19 ‘‘(vi) perform various forms of engagement 

20 with, and outreach to, eligible diabetes prevention 

21 program individuals, including those participating in 

22 programs furnished under contract with a diabetes 

23 prevention program delivery partner; 

24 ‘‘(vii) comply with all program integrity require25 ments as established by the Secretary; and 

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1 ‘‘(viii) perform such other functions as estab2 lished by the Secretary.’’. 

3 (2) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

4 of the Social Security Act (42 U.S.C. 1395l(a)(1)) 

5 is amended— 

6 (A) by striking ‘‘and (Z)’’ and inserting 

7 ‘‘(Z)’’; and 

8 (B) by inserting before the semicolon at 

9 the end the following: ‘‘, and (AA) with respect 

10 to items and services furnished under a diabetes 

11 prevention program (as defined in section 

12 1861(iii)(1)), the amount paid shall be 100 per13 cent of (i) except as provided in clause (ii), the 

14 lesser of the actual charge for the items and 

15 services or the amount determined under the 

16 fee schedule that applies to such items and 

17 services under this part, as determined by the 

18 Secretary, and (ii) in the case of such items and 

19 services that are covered OPD services (as de20 fined in subsection (t)(1)(B)), the amount de21 termined under subsection (t)’’. 

22 (3) WAIVER OF APPLICATION OF DEDUCT23 IBLE.—The first sentence of section 1833(b) of the 

24 Social Security Act (42 U.S.C. 1395l(b)) is amend25 ed— 

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1 (A) by striking ‘‘and’’ before ‘‘(10)’’; and 

2 (B) by inserting before the period the fol3 lowing: ‘‘, and (11) such deductible shall not 

4 apply with respect to items and services under 

5 a diabetes prevention program (as defined in 

6 section 1861(iii)(1))’’. 

7 (4) ASSIGNMENT OF CLAIMS.—Section 

8 1842(b)(18)(C) of the Social Security Act (42 

9 U.S.C. 1395u(b)(18)(C)) is amended by adding at 

10 the end the following new clause: 

11 ‘‘(vii) A qualified diabetes prevention program 

12 provider (as defined in section 1861(iii)(3)(A)).’’. 

13 (5) EXCLUSION OF ITEMS AND SERVICES

14 UNDER A DIABETES PREVENTION PROGRAM FROM

15 SKILLED NURSING FACILITY PROSPECTIVE PAYMENT

16 SYSTEM.—Section 1888(e)(2)(A)(ii) of the Social Se17 curity Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amend18 ed by inserting ‘‘items and services under a diabetes 

19 prevention program (as defined in section 

20 1861(iii)(1)),’’ after ‘‘qualified psychologist serv21 ices,’’. 

22 (6) INCLUSION IN FEDERALLY QUALIFIED

23 HEALTH CENTER SERVICES.—Section 1861(aa)(3) of 

24 the Social Security Act (42 U.S.C. 1395x(aa)(3)) is 

25 amended— 

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1 (A) in subparagraph (A), by striking 

2 ‘‘and’’ at the end; 

3 (B) in subparagraph (B), by striking the 

4 comma at the end and inserting ‘‘; and’’; and 

5 (C) by adding after subparagraph (B) the 

6 following new subparagraph: 

7 ‘‘(C) items and services under a diabetes pre8 vention program (as defined in section 

9 1861(iii)(1)),’’. 

10 (7) SPECIAL CONSIDERATION FOR THE DUAL

11 ELIGIBLE POPULATION.—In implementing the 

12 amendments made by this subsection, the Secretary 

13 of Health and Human Services shall give special 

14 consideration to the needs of individuals who are du15 ally eligible for benefits under the Medicare and 

16 Medicaid programs. 

17 (8) EVALUATION AND REPORT TO CONGRESS.— 

18 (A) EVALUATION.—The Secretary of 

19 Health and Human Services shall conduct an 

20 evaluation on the coverage of items and services 

21 under a diabetes prevention program under the 

22 Medicare program, as added by the amend23 ments made by this subsection. Such evaluation 

24 shall include an analysis of— 

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1 (i) the impact of the provision of such 

2 coverage on Medicare beneficiaries, includ3 ing the impact on various populations, 

4 such as individuals who are dually eligible 

5 for benefits under the Medicare and Med6 icaid programs and individuals living in 

7 rural or medically underserved areas, and 

8 the impact of the provision of such cov9 erage on health disparities; 

10 (ii) the rate at which physicians refer 

11 eligible diabetes prevention program indi12 viduals to diabetes prevention programs 

13 under the Medicare program; 

14 (iii) Medicare beneficiary participation 

15 levels in diabetes prevention programs 

16 under the Medicare program, including 

17 program completion rates, and the aware18 ness of Medicare beneficiaries of the ben19 efit; 

20 (iv) the health outcomes resulting 

21 from completion of a diabetes prevention 

22 program under the Medicare program, in23 cluding any measurable variations in out24 come between the program settings de25 scribed in clauses (i) through (iii) of secmstockstill on DSK4VPTVN1PROD with BILLS

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1 tion 1861(iii)(1)(C) of the Social Security 

2 Act, as added by paragraph (1); 

3 (v) program integrity protections im4 portant to diabetes prevention programs 

5 under the Medicare program; and 

6 (vi) other areas determined appro7 priate by the Secretary. 

8 (B) REPORT.—Not later than January 1, 

9 2021, the Secretary of Health and Human 

10 Services shall submit to Congress a report on 

11 the evaluation conducted under subparagraph 

12 (A), together with recommendations for such 

13 legislation and administrative actions as the 

14 Secretary determines appropriate. 

15 (9) EFFECTIVE DATE.—The amendments made 

16 by paragraphs (1) through (6) shall apply with re17 spect to services furnished on or after January 1, 

18 2017. 

19 (b) INCLUSION OF REFERRAL RATES TO DIABETES

20 PREVENTION PROGRAMS IN MEDICARE QUALITY RE21 PORTING REQUIREMENTS.—Section 1848(k)(2)(C)(i) of 

22 the Social Security Act (42 U.S.C. 1395w–4(k)(2)(C)(i)) 

23 is amended by adding at the end the following new sen24 tence: ‘‘For purposes of reporting data on quality meas25 ures for covered professional services furnished during 

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1 2020 and each subsequent year, the quality measures 

2 specified under this paragraph shall include a measure 

3 with respect to referrals of eligible diabetes prevention 

4 program individuals (as defined in paragraph (2) of sec5 tion 1861(iii)) to diabetes prevention programs (as defined 

6 in paragraph (1) of such section).’’. 

7 (c) INCLUSION OF DIABETES RISK ASSESSMENT IN

8 MEDICARE PERSONALIZED PREVENTION PLAN.— 

9 (1) IN GENERAL.—Section 1861(hhh)(2)(C) of 

10 the Social Security Act (42 U.S.C. 

11 1395x(hhh)(2)(C)) is amended by inserting before 

12 the period at the end the following: ‘‘, and an assess13 ment of whether the individual is an individual at 

14 risk for diabetes (as defined in subsection (yy)(2))’’. 

15 (2) EFFECTIVE DATE.—The amendments made 

16 by this subsection shall apply to personalized preven17 tion plans created or updated on or after January 

18 1, 2017. 

19 SEC. 3. FINDINGS; SENSE OF THE SENATE REGARDING DIA20 BETES PREVENTION UNDER THE MEDICAID 

21 PROGRAM. 

22 (a) FINDINGS.—Congress makes the following find23 ings: 

24 (1) The prevalence and cost of diabetes is a sig25 nificant concern for State Medicaid programs. By 

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1 2021, the Medicaid program is expected to cover 

2 13,000,000 people with diabetes and about 

3 9,000,000 people who may have pre-diabetes. By 

4 2021, States will spend an estimated 

5 $83,000,000,000 on individuals with diabetes or pre6 diabetes. 

7 (2) The National Diabetes Prevention Program, 

8 as established by the Centers for Disease Control 

9 and Prevention, has been proven to reduce the onset 

10 of diabetes in at-risk adults by 58 percent, using a 

11 cost-effective, community-based intervention. 

12 (b) SENSE OF THE SENATE.—It is the sense of the 

13 Senate that the National Diabetes Prevention Program 

14 presents an opportunity for States to reduce the incidence 

15 of diabetes among individuals enrolled in their Medicaid 

16 programs. 

Æ 

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