II

105TH CONGRESS

1ST SESSION S. 102

To amend title XVIII of the Social Security Act to improve Medicare treatment and education for beneficiaries with diabetes by providing coverage

of diabetes outpatient self-management training services and uniform

coverage of blood-testing strips for individuals with diabetes.

IN THE SENATE OF THE UNITED STATES

JANUARY 21, 1997

Mr. BREAUX (for himself, Mr. AKAKA, Mr. BINGAMAN, Mr. CHAFEE, Mr.

COCHRAN, Mr. CRAIG, Mr. GLENN, Mr. JEFFORDS, Mr. LEAHY, Mr.

INOUYE, Ms. MIKULSKI, and Mr. REID) 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

Medicare treatment and education for beneficiaries with

diabetes by providing coverage of diabetes outpatient selfmanagement training services and uniform coverage of

blood-testing strips 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 Education and Supplies Amendments of 1997’’.
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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 graphs (N) and (O); and

7 (2) by inserting after subparagraph (O) the fol8 lowing new subparagraph:

9 ‘‘(P) diabetes outpatient self-management train10 ing services (as defined in subsection (oo)); and’’.

11 (b) DEFINITION.—Section 1861 of the Social Secu12 rity Act (42 U.S.C. 1395x) is amended by adding at the

13 end the following new subsection:

14 ‘‘Diabetes Outpatient Self-management Training Services

15 ‘‘(oo)(1) The term ‘diabetes outpatient self-manage16 ment training services’ means educational and training

17 services furnished to an individual with diabetes by or

18 under arrangements with a certified provider (as described

19 in paragraph (2)(A)) in an outpatient setting by an indi20 vidual or entity who meets the quality standards described

21 in paragraph (2)(B), but only if the physician who is man22 aging the individual’s diabetic condition certifies that such

23 services are needed under a comprehensive plan of care

24 related to the individual’s diabetic condition to provide the

25 individual with necessary skills and knowledge (including

26 skills related to the self-administration of injectable drugs)
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1 to participate in the management of the individual’s condi2 tion.

3 ‘‘(2) In paragraph (1)—

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

5 entity that, in addition to providing diabetes out6 patient self-management training services, provides

7 other items or services for which payment may be

8 made under this title; and

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

10 standards described in this paragraph if the individ11 ual or entity meets quality standards established by

12 the Secretary, except that the individual or entity

13 shall be deemed to have met such standards if the

14 individual or entity meets applicable standards origi15 nally established by the National Diabetes Advisory

16 Board and subsequently revised by organizations

17 who participated in the establishment of standards

18 by such Board, or is recognized by the American Di19 abetes Association as meeting standards for furnish20 ing 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, 1998.

9 SEC. 3. MEDICARE COVERAGE OF BLOOD-TESTING STRIPS

10 FOR INDIVIDUALS WITH DIABETES.

11 (a) INCLUDING STRIPS AS DURABLE MEDICAL

12 EQUIPMENT.—Section 1861(n) of the Social Security Act

13 (42 U.S.C. 1395x(n)) is amended by striking the semi14 colon in the first sentence and inserting the following: ‘‘,

15 and includes blood-testing strips for individuals with dia16 betes without regard to injection of insulin (as determined

17 under standards established by the Secretary in consulta18 tion with the American Diabetes Association);’’.

19 (b) PAYMENT FOR STRIPS BASED ON METHODOLOGY

20 FOR INEXPENSIVE AND ROUTINELY PURCHASED EQUIP21 MENT.—Section 1834(a)(2)(A) of such Act (42 U.S.C.

22 1395m(a)(2)(A)) is amended—

23 (1) by striking ‘‘or’’ at the end of clause (ii);

24 (2) by adding ‘‘or’’ at the end of clause (iii);

25 and
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1 (3) by inserting after clause (iii) the following

2 new clause:

3 ‘‘(iv) which is a blood-testing strip for

4 an individual with diabetes,’’.

5 (c) EFFECTIVE DATE.—The amendments made by

6 this section shall apply to blood-testing strips furnished

7 on or after January 1, 1998.

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