II 

117TH CONGRESS 

1ST SESSION S. 2203 

To amend title XVIII of the Social Security Act to improve access to diabetes 

outpatient self-management training services, to require the Center for 

Medicare and Medicaid Innovation to test the provision of virtual diabetes 

outpatient self-management training services, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 24, 2021 

Mrs. SHAHEEN (for herself, Ms. COLLINS, Mr. KING, Mr. CRAMER, Ms. 

SMITH, Ms. SINEMA, Ms. STABENOW, Mr. BROWN, Mr. VAN HOLLEN, 

and Mr. PETERS) 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 outpatient self-management training 

services, to require the Center for Medicare and Medicaid 

Innovation to test the provision of virtual diabetes outpatient self-management training services, 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 ‘‘Expanding Access to 

5 Diabetes Self-Management Training Act of 2021’’. 


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1 SEC. 2. IMPROVING ACCESS TO DIABETES OUTPATIENT 

2 SELF-MANAGEMENT TRAINING SERVICES. 

3 (a) IN GENERAL.—Section 1861(qq) of the Social Se4 curity Act (42 U.S.C. 1395x(qq)) is amended— 

5 (1) in paragraph (1)— 

6 (A) by striking ‘‘the Secretary determines 

7 appropriate’’ and inserting ‘‘specified in para8 graph (3)’’; 

9 (B) by inserting ‘‘or qualified nonphysician 

10 practitioner’’ after ‘‘only if the physician’’; and 

11 (C) by inserting ‘‘(or other physician or 

12 qualified nonphysician practitioner furnishing 

13 items or services to such individual, in coordina14 tion with the physician or qualified nonphysi15 cian practitioner managing such individual’s di16 abetic condition)’’ after ‘‘managing the individ17 ual’s diabetic condition’’; 

18 (2) in paragraph (2)(B), by striking ‘‘para19 graph’’ and inserting ‘‘subparagraph’’; and 

20 (3) by adding at the end the following new 

21 paragraph: 

22 ‘‘(3) For purposes of paragraph (1), the times speci23 fied in this paragraph are the following: 

24 ‘‘(A) An initial 10 hours of educational and 

25 training services to remain available until used. 


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1 ‘‘(B) No more than 2 hours of individual or 

2 group educational and training services each year, 

3 including the year in which the initial 10 hours de4 scribed in subparagraph (A) are completed.’’. 

5 (b) MEDICAL NUTRITION THERAPY SERVICES.—Sec6 tion 1861(s)(2)(V) of such Act (42 U.S.C. 

7 1395x(s)(2)(V)) is amended— 

8 (1) by striking clause (i); 

9 (2) by redesignating clauses (ii) and (iii) as 

10 clauses (i) and (ii), respectively; and 

11 (3) in clause (ii), as so redesignated, by striking 

12 ‘‘after consideration of’’ and inserting ‘‘consistent 

13 with’’. 

14 (c) COST-SHARING.—Section 1833 of the Social Se15 curity Act (42 U.S.C. 1395l) is amended— 

16 (1) in subsection (a)(1)— 

17 (A) by striking ‘‘and (DD)’’ and inserting 

18 ‘‘(DD)’’; and 

19 (B) by striking the semicolon at the end 

20 and inserting ‘‘and (EE) with respect to diabe21 tes outpatient self-management training serv22 ices (as defined in section 1861(qq)), the 

23 amount paid shall be 100 percent of the lesser 

24 of the actual charge for the services or the 


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1 amount determined under the fee schedule that 

2 applies to such services under this part;’’; and 

3 (2) in subsection (b), in the first sentence— 

4 (A) by striking ‘‘and (12)’’ and inserting 

5 ‘‘(12)’’; and 

6 (B) by striking the period at the end and 

7 inserting ‘‘, and (13) such deductible shall not 

8 apply with respect to diabetes outpatient self9 management training services (as defined in 

10 section 1861(qq)).’’ 

11 (d) APPLICATION.—The amendments made by this 

12 section shall apply with respect to items and services fur13 nished on or after January 1, 2023. 

14 SEC. 3. CMI TESTING OF PROVIDING VIRTUAL DIABETES 

15 OUTPATIENT SELF-MANAGEMENT TRAINING 

16 SERVICES. 

17 Section 1115A of the Social Security Act (42 U.S.C. 

18 1315a) is amended— 

19 (1) in subsection (b)(2)(A), by adding at the 

20 end the following new sentence: ‘‘The models se21 lected under this subparagraph shall include the 

22 testing of the model described in subsection (h).’’; 

23 and 

24 (2) by adding at the end the following new sub25 section: 


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1 ‘‘(h) TESTING OF PROVIDING VIRTUAL DIABETES

2 OUTPATIENT SELF-MANAGEMENT TRAINING SERV3 ICES.— 

4 ‘‘(1) ESTABLISHMENT.—Not later than Janu5 ary 1, 2023, the Secretary shall implement a model 

6 to test the impact of providing coverage under title 

7 XVIII for virtual diabetes outpatient self-manage8 ment training services furnished to applicable bene9 ficiaries with respect to improved health outcomes 

10 for such applicable beneficiaries and reduced expend11 itures under such title XVIII. 

12 ‘‘(2) MODEL DESIGN.— 

13 ‘‘(A) IN GENERAL.—The Secretary shall 

14 design the model under this subsection in such 

15 a manner to allow for the evaluation of demo16 graphic characteristics of applicable bene17 ficiaries participating in such model and the ex18 tent to which such model accomplishes the fol19 lowing purposes: 

20 ‘‘(i) Improvement in health outcomes 

21 with respect to the diabetic conditions, in22 cluding by reducing A1c levels. 

23 ‘‘(ii) Reduced hospitalizations due to 

24 diabetic-related complications. 


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1 ‘‘(iii) Increased utilization of diabetes 

2 outpatient self-management training serv3 ices as evidenced by, for example, Medicare 

4 beneficiary participation and utilization of 

5 covered hours during the first year and 

6 subsequent years or use of diabetes out7 patient self-management training services 

8 in rural and underserved communities. 

9 ‘‘(iv) Improved medication adherence. 

10 ‘‘(v) Reduced expenditures under this 

11 title attributable to the model. 

12 ‘‘(B) CONSULTATION.—In designing the 

13 model under this subsection, the Secretary 

14 shall, not later than 3 months after the date of 

15 the enactment of this subsection, consult with 

16 stakeholders in the field of diabetes care and 

17 education, clinicians in the primary care com18 munity, experts in digital health, and bene19 ficiary groups. 

20 ‘‘(3) DEFINITIONS.—In this subsection: 

21 ‘‘(A) APPLICABLE BENEFICIARY.—The 

22 term ‘applicable beneficiary’ means an indi23 vidual with diabetes as described in section 

24 1861(qq). 


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1 ‘‘(B) QUALIFIED WEB-BASED PROGRAM.— 

2 The term ‘qualified web-based program’ means 

3 a web-based program— 

4 ‘‘(i) designed to furnish educational 

5 and training services to an individual with 

6 diabetes to ensure therapy compliance with 

7 respect to the individual’s diabetic condi8 tion or to provide the individual with nec9 essary skills and knowledge (including 

10 skills related to the self-administration of 

11 injectable drugs) to participate in the indi12 vidual’s management of such condition; 

13 and 

14 ‘‘(ii) that meets the quality standards 

15 described in section 1861(qq)(2)(B). 

16 ‘‘(C) VIRTUAL DIABETES OUTPATIENT

17 SELF-MANAGEMENT TRAINING SERVICES.—The 

18 term ‘virtual diabetes outpatient self-manage19 ment training services’ means any diabetes out20 patient self-management training services (as 

21 defined in section 1861(qq)) furnished by a 

22 qualified web-based program for synchronous or 

23 asynchronous diabetes outpatient self-manage24 ment training services.’’. 

Æ 


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