I 

114TH CONGRESS 

1ST SESSION H. R. 2102 

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

of diabetes among Medicare beneficiaries, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 29, 2015 

Mrs. DAVIS of California (for herself, Mr. KING of New York, Mr. RIBBLE, 

Mr. TAKAI, Mr. SMITH of New Jersey, and Mr. FITZPATRICK) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce, and in addition to the Committee on Ways and Means, for 

a period to be subsequently determined by the Speaker, in each case for 

consideration of such provisions as fall within the jurisdiction of the committee concerned 

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’’. 


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1 SEC. 2. DIABETES PREVENTION UNDER THE MEDICARE 

2 PROGRAM. 

3 (a) COVERAGE OF DIABETES PREVENTION PROGRAM

4 SERVICES.— 

5 (1) COVERAGE OF SERVICES.— 

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

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

8 is amended— 

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

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

11 (ii) in subparagraph (FF), by insert12 ing ‘‘and’’ after the semicolon at the end; 

13 and 

14 (iii) by adding at the end the fol15 lowing new subparagraph: 

16 ‘‘(GG) items and services furnished under a di17 abetes prevention program (as defined in subsection 

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

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

20 (B) DEFINITIONS.—Section 1861 of the 

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

22 amended by adding at the end the following 

23 new subsection: 


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1 ‘‘Diabetes Prevention Program; Eligible Diabetes Preven2 tion Program Individual; Qualified Diabetes Preven3 tion Program Provider 

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

5 means a program that— 

6 ‘‘(i) meets the criteria described in subpara7 graph (B); and 

8 ‘‘(ii) is furnished by a qualified diabetes preven9 tion program provider (as defined in paragraph 

10 (3)(A)). 

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

12 diabetes prevention program. Such criteria shall be in ac13 cordance with the standards under the National Diabetes 

14 Prevention Program, as established by the Centers for 

15 Disease Control and Prevention, and shall require that the 

16 program complies with the Federal regulations (con17 cerning the privacy of individually identifiable health in18 formation) promulgated under section 264(c) of the 

19 Health Insurance Portability and Accountability Act of 

20 1996. In establishing such criteria, the Secretary may also 

21 consider other factors or clinical evidence as the Secretary 

22 determines appropriate. 

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

24 prevention program may, as determined appropriate by 

25 the Secretary, be furnished in-person in a community setVerDate Sep 11 2014 22:25 May 11, 2015 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2102.IH H2102

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1 ting, virtually, or via one or more proven distance-learning 

2 modalities. 

3 ‘‘(D) The Secretary shall establish procedures under 

4 which a qualified diabetes prevention program provider 

5 may contract with a diabetes prevention program delivery 

6 partner to furnish the items and services under a diabetes 

7 prevention program. Items and services may be furnished 

8 in one or some combination of the settings described in 

9 subparagraph (C). For purposes of this subsection, the 

10 term ‘diabetes prevention program delivery partner’ means 

11 an entity, including non-profit organizations, public and 

12 private hospitals, State and local departments of public 

13 health, and Federally qualified health centers, that meets 

14 criteria established by the Secretary. Such criteria shall 

15 be in accordance with the standards under the National 

16 Diabetes Prevention Program, as established by the Cen17 ters for Disease Control and Prevention. In establishing 

18 such criteria, the Secretary may also consider other fac19 tors or clinical evidence as the Secretary determines ap20 propriate. 

21 ‘‘(2)(A) The term ‘eligible diabetes prevention pro22 gram individual’ means an individual at risk for diabetes 

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

24 items and services under a diabetes prevention program, 


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1 as determined based on criteria established by the Sec2 retary. 

3 ‘‘(B) The criteria established under subparagraph 

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

5 National Diabetes Prevention Program, as established by 

6 the Centers for Disease Control and Prevention. In estab7 lishing such criteria, the Secretary may also consider other 

8 factors or clinical evidence as the Secretary determines ap9 propriate. 

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

11 program provider’ means any entity, including a Federally 

12 qualified health center, that the Secretary determines— 

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

14 under a diabetes prevention program; and 

15 ‘‘(II) meets criteria established by the Sec16 retary, in consultation with the Centers for Disease 

17 Control and Prevention. 

18 ‘‘(ii) A qualified diabetes prevention program pro19 vider may be, as determined appropriate by the Secretary, 

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

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

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

23 any other appropriate entity. 

24 ‘‘(B) A qualified diabetes prevention program pro25 vider shall— 


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1 ‘‘(i) furnish the items and services under the di2 abetes prevention program through a delivery part3 ner (pursuant to paragraph (1)(D)) unless no such 

4 delivery partner is available; 

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

6 a diabetes prevention program (including attendance 

7 and observed weight loss of participating individuals) 

8 through defined systems which cannot rely solely on 

9 data self-reported by participating individuals, in10 cluding outcomes of programs furnished under con11 tract with a diabetes prevention program delivery 

12 partner as defined in paragraph (1)(D); 

13 ‘‘(iii) implement business processes to manage 

14 program workflow, such as eligibility, reporting, 

15 claims billing, class scheduling, and enrollment; 

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

17 beneficiary eligibility (as described in paragraph 

18 (2)); 

19 ‘‘(v) comply with applicable laws and regula20 tions and ensure such compliance by a diabetes pre21 vention program delivery partner; 

22 ‘‘(vi) perform various forms of engagement 

23 with, and outreach to, eligible diabetes prevention 

24 program individuals, including those participating in 


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1 programs furnished under contract with a diabetes 

2 prevention program delivery partner; 

3 ‘‘(vii) comply with all program integrity require4 ments as established by the Secretary; and 

5 ‘‘(viii) perform such other functions as estab6 lished by the Secretary.’’. 

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

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

9 is amended— 

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

11 ‘‘(Z)’’; and 

12 (B) by inserting before the semicolon at 

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

14 to items and services furnished under a diabetes 

15 prevention program (as defined in section 

16 1861(iii)(1)), the amount paid shall be 100 per17 cent of (i) except as provided in clause (ii), the 

18 lesser of the actual charge for the items and 

19 services or the amount determined under the 

20 fee schedule that applies to such items and 

21 services under this part, as determined by the 

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

23 services that are covered OPD services (as de24 fined in subsection (t)(1)(B)), the amount de25 termined under subsection (t)’’. 


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1 (3) WAIVER OF APPLICATION OF DEDUCT2 IBLE.—The first sentence of section 1833(b) of the 

3 Social Security Act (42 U.S.C. 1395l(b)) is amend4 ed— 

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

6 (B) by inserting before the period the fol7 lowing: ‘‘, and (11) such deductible shall not 

8 apply with respect to items and services under 

9 a diabetes prevention program (as defined in 

10 section 1861(iii)(1))’’. 

11 (4) ASSIGNMENT OF CLAIMS.—Section 

12 1842(b)(18)(C) of the Social Security Act (42 

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

14 the end the following new clause: 

15 ‘‘(vii) A qualified diabetes prevention program 

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

17 (5) EXCLUSION OF ITEMS AND SERVICES

18 UNDER A DIABETES PREVENTION PROGRAM FROM

19 SKILLED NURSING FACILITY PROSPECTIVE PAYMENT

20 SYSTEM.—Section 1888(e)(2)(A)(ii) of the Social Se21 curity Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amend22 ed by inserting ‘‘items and services under a diabetes 

23 prevention program (as defined in section 

24 1861(iii)(1)),’’ after ‘‘qualified psychologist serv25 ices,’’. 


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1 (6) INCLUSION IN FEDERALLY QUALIFIED

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

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

4 amended— 

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

6 ‘‘and’’ at the end; 

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

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

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

10 following new subparagraph: 

11 ‘‘(C) items and services under a diabetes pre12 vention program (as defined in section 

13 1861(iii)(1)),’’. 

14 (7) SPECIAL CONSIDERATION FOR THE DUAL

15 ELIGIBLE POPULATION.—In implementing the 

16 amendments made by this subsection, the Secretary 

17 of Health and Human Services shall give special 

18 consideration to the needs of individuals who are du19 ally eligible for benefits under the Medicare and 

20 Medicaid programs. 

21 (8) EVALUATION AND REPORT TO CONGRESS.— 

22 (A) EVALUATION.—The Secretary of 

23 Health and Human Services shall conduct an 

24 evaluation on the coverage of items and services 

25 under a diabetes prevention program under the 


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1 Medicare program, as added by the amend2 ments made by this subsection. Such evaluation 

3 shall include an analysis of— 

4 (i) the impact of the provision of such 

5 coverage on Medicare beneficiaries, includ6 ing the impact on various populations, 

7 such as individuals who are dually eligible 

8 for benefits under the Medicare and Med9 icaid programs and individuals living in 

10 rural or medically underserved areas, and 

11 the impact of the provision of such cov12 erage on health disparities; 

13 (ii) the rate at which physicians refer 

14 eligible diabetes prevention program indi15 viduals to diabetes prevention programs 

16 under the Medicare program; 

17 (iii) Medicare beneficiary participation 

18 levels in diabetes prevention programs 

19 under the Medicare program and the 

20 awareness of Medicare beneficiaries of the 

21 benefit; 

22 (iv) the health outcomes resulting 

23 from completion of a diabetes prevention 

24 program under the Medicare program, in25 cluding any measurable variations in outVerDate Sep 11 2014 22:25 May 11, 2015 Jkt 049200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2102.IH H2102

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1 come between different program settings 

2 described in section 1861(iii)(1)(C) of the 

3 Social Security Act, as added by paragraph 

4 (1)(B); 

5 (v) program integrity protections im6 portant to diabetes prevention programs 

7 under the Medicare program; and 

8 (vi) other areas determined appro9 priate by the Secretary. 

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

11 2021, the Secretary of Health and Human 

12 Services shall submit to Congress a report on 

13 the evaluation conducted under subparagraph 

14 (A), together with recommendations for such 

15 legislation and administrative actions as the 

16 Secretary determines appropriate. 

17 (9) EFFECTIVE DATE.—The amendments made 

18 by paragraphs (1) through (6) shall apply with re19 spect to services furnished on or after January 1, 

20 2017. 

21 (b) INCLUSION OF REFERRAL RATES TO DIABETES

22 PREVENTION PROGRAMS IN THE MEDICARE PHYSICIAN

23 QUALITY REPORTING SYSTEM.—Section 1848(k)(2)(C)(i) 

24 of the Social Security Act (42 U.S.C. 1395w– 

25 4(k)(2)(C)(i)) is amended by adding at the end the folVerDate Sep 11 2014 22:25 May 11, 2015 Jkt 049200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2102.IH H2102

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1 lowing new sentence: ‘‘For purposes of reporting data on 

2 quality measures for covered professional services fur3 nished during 2020 and each subsequent year, the quality 

4 measures specified under this paragraph shall include a 

5 measure with respect to referrals of eligible diabetes pre6 vention program individuals (as defined in paragraph (2) 

7 of section 1861(iii)) to diabetes prevention programs (as 

8 defined in paragraph (1) of such section).’’. 

9 (c) INCLUSION OF DIABETES RISK ASSESSMENT IN

10 MEDICARE PERSONALIZED PREVENTION PLAN.— 

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

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

13 1395x(hhh)(2)(C)) is amended by inserting before 

14 the period at the end the following: ‘‘, and an assess15 ment of whether the individual is an individual at 

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

17 (2) EFFECTIVE DATE.—The amendment made 

18 by this subsection shall apply to personalized preven19 tion plans created or updated on or after January 

20 1, 2017. 

21 SEC. 3. FINDINGS; SENSE OF THE HOUSE OF REPRESENTA22 TIVES REGARDING DIABETES PREVENTION 

23 UNDER THE MEDICAID PROGRAM. 

24 (a) FINDINGS.—Congress makes the following find25 ings: 


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1 (1) The prevalence and cost of diabetes is a sig2 nificant concern for State Medicaid programs. By 

3 2021, the Medicaid program is expected to cover 

4 13,000,000 people with diabetes and about 

5 9,000,000 people who may have pre-diabetes. By 

6 2021, States will spend an estimated 

7 $83,000,000,000 on individuals with diabetes or pre8 diabetes. 

9 (2) The National Diabetes Prevention Program, 

10 as established by the Centers for Disease Control 

11 and Prevention, has been proven to reduce the onset 

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

13 cost-effective, community-based intervention. 

14 (b) SENSE OF THE HOUSE OF REPRESENTATIVES.— 

15 It is the sense of the House of Representatives that the 

16 National Diabetes Prevention Program presents an oppor17 tunity for States to reduce the incidence of diabetes among 

18 individuals enrolled in their Medicaid programs. 

Æ 


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