I 

113TH CONGRESS 

1ST SESSION H. R. 1274 

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

self-management training by authorizing certified diabetes educators to 

provide diabetes self-management training services, including as part 

of telehealth services, under part B of the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 19, 2013 

Mr. WHITFIELD (for himself and Ms. DEGETTE) 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 improve 

access to diabetes self-management training by authorizing certified diabetes educators to provide diabetes selfmanagement training services, including as part of telehealth services, under part B of the Medicare program. 

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 ‘‘Access to Quality Dia5 betes Education Act of 2013’’. 


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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) The Centers for Disease Control and Pre4 vention (hereinafter ‘‘CDC’’) report that nearly 

5 26,000,000 Americans have diabetes, in addition to 

6 an estimated 79,000,000 Americans who have 

7 prediabetes, an increase of 24,000,000 Americans 

8 with either diabetes or prediabetes since 2008. Peo9 ple with prediabetes are at increased risk of devel10 oping Type 2 diabetes or cardiovascular disease. 

11 (2) Diabetes impacts 8.3 percent of all Ameri12 cans and 11.3 percent of American adults. The CDC 

13 estimates that as many as 1 in 3 Americans will 

14 have diabetes by 2050 if current trends continue. 

15 (3) According to the American Diabetes Asso16 ciation, the total costs of diagnosed diabetes have 

17 risen to $245 billion in 2012 from $174 billion in 

18 2007, when the cost was last examined by the CDC. 

19 This figure represents a 41 percent increase over a 

20 five-year period. 

21 (4) One in 3 Medicare dollars is currently spent 

22 on people with diabetes. 

23 (5) There were 11.3 million diabetes related 

24 emergency room visits in 2008, compared with 9.5 

25 million in 2000, an increase of 11 percent. 


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1 (6) According to the CDC, health care pro2 viders are finding statistically significant increases 

3 in the prevalence of Type 2 diabetes in children and 

4 adolescents. 

5 (7) Diabetes self-management training (herein6 after ‘‘DSMT’’), also called diabetes education, pro7 vides critical knowledge and skills training to pa8 tients with diabetes, helping them manage medica9 tions, address nutritional issues, facilitate diabetes10 related problem solving, and make other critical life11 style changes to effectively manage their diabetes. 

12 Evidence shows that individuals participating in 

13 DSMT programs are able to progress along the con14 tinuum necessary to make sustained behavioral 

15 changes in order to manage their diabetes. 

16 (8) A certified diabetes educator is a State li17 censed or registered health care professional who 

18 specializes in helping people with diabetes develop 

19 the self-management skills needed to stay healthy 

20 and avoid costly acute complications and emergency 

21 care, as well as debilitating secondary conditions 

22 caused by diabetes. 

23 (9) Diabetes self-management training has been 

24 proven effective in helping to reduce the risks and 

25 complications of diabetes and is a vital component of 


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1 an overall diabetes treatment regimen. Patients who 

2 have received training from a certified diabetes edu3 cator are better able to implement the treatment 

4 plan received from a physician skilled in diabetes 

5 treatment. 

6 (10) Lifestyle changes, such as those taught by 

7 certified diabetes educators, directly contribute to 

8 better glycemic control and reduced complications 

9 from diabetes. Evidence shows that the potential for 

10 prevention of the most serious medical complications 

11 caused by diabetes to be as high as 90 percent 

12 (blindness), 85 percent (amputations), and 50 per13 cent (heart disease and stroke) with proper medical 

14 treatment and active self-management. 

15 (11) In recognition of the important role of 

16 DSMT programs, the CDC in 2012 awarded fund17 ing to expand the National Diabetes Prevention Pro18 gram to help prevent the onset of Type 2 diabetes 

19 for individuals at high risk. 

20 (12) The net savings to the Medicare program 

21 of ensuring that beneficiaries have access to quality 

22 DSMT is estimated to be $2,000,000,000 over 10 

23 years. 

24 (13) Despite its effectiveness in reducing diabe25 tes-related complications and associated costs, diabeVerDate Mar 15 2010 23:23 Mar 25, 2013 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1274.IH H1274

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1 tes self-management training has been recognized by 

2 the Centers for Medicare & Medicaid Services as an 

3 underutilized Medicare benefit, even after more than 

4 a decade of coverage. 

5 (14) Enhancing access to diabetes self-manage6 ment training programs that are certified as nec7 essary by the patient’s treating physician and taught 

8 by certified diabetes educators is an important pub9 lic policy goal that can help improve health out10 comes, ensure quality, and reduce escalating diabe11 tes-related health costs. 

12 SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU13 CATORS AS AUTHORIZED PROVIDERS OF 

14 MEDICARE DIABETES OUTPATIENT SELF15 MANAGEMENT TRAINING SERVICES. 

16 (a) IN GENERAL.—Section 1861(qq) of the Social Se17 curity Act (42 U.S.C. 1395x(qq)) is amended— 

18 (1) in paragraph (1), by striking ‘‘by a certified 

19 provider (as described in paragraph (2)(A)) in an 

20 outpatient setting’’ and inserting ‘‘in an outpatient 

21 setting by a certified diabetes educator (as defined 

22 in paragraph (3)) or by a certified provider (as de23 scribed in paragraph (2)(A))’’; and 

24 (2) by adding at the end the following new 

25 paragraphs: 


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1 ‘‘(3) For purposes of paragraph (1), the term ‘cer2 tified diabetes educator’ means an individual— 

3 ‘‘(A) who is licensed or registered by the State 

4 in which the services are performed as a certified di5 abetes educator; or 

6 ‘‘(B) who— 

7 ‘‘(i) is licensed or registered by the State 

8 in which the services are performed as a health 

9 care professional; 

10 ‘‘(ii) specializes in teaching individuals 

11 with diabetes to develop the necessary skills and 

12 knowledge to manage the individual’s diabetic 

13 condition; and 

14 ‘‘(iii) is certified as a diabetes educator by 

15 a recognized certifying body (as defined in 

16 paragraph (4)). 

17 ‘‘(4) For purposes of paragraph (3)(B)(iii), the term 

18 ‘recognized certifying body’ means a certifying body for 

19 diabetes educators which is recognized by the Secretary 

20 as authorized to grant certification of diabetes educators 

21 for purposes of this subsection pursuant to standards es22 tablished by the Secretary.’’. 

23 (b) TREATMENT AS A PRACTITIONER, INCLUDING

24 FOR TELEHEALTH SERVICES.—Section 1842(b)(18)(C) of 


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1 the such Act (42 U.S.C. 1395u(b)(18)(C)) is amended by 

2 adding at the end the following new clause: 

3 ‘‘(vii) A certified diabetes educator (as defined 

4 in section 1861(qq)(3)).’’. 

5 (c) GAO STUDY AND REPORT.— 

6 (1) STUDY.—The Comptroller General of the 

7 United States shall conduct a study to identify the 

8 barriers that exist for Medicare beneficiaries with di9 abetes in accessing diabetes self-management train10 ing services under the Medicare program, including 

11 economic and geographic barriers and availability of 

12 appropriate referrals and access to adequate and 

13 qualified providers. 

14 (2) REPORT.—Not later than 1 year after the 

15 date of the enactment of this Act, the Comptroller 

16 General of the United States shall submit to Con17 gress a report on the study conducted under para18 graph (1). 

19 (d) AHRQ DEVELOPMENT OF RECOMMENDATIONS

20 FOR OUTREACH METHODS AND REPORT.— 

21 (1) DEVELOPMENT OF RECOMMENDATIONS.— 

22 The Director of the Agency for Healthcare Research 

23 and Quality shall, through use of a workshop and 

24 other appropriate means, develop a series of rec25 ommendations on effective outreach methods to eduVerDate Mar 15 2010 23:23 Mar 25, 2013 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1274.IH H1274

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1 cate physicians and other health care providers as 

2 well as the public about the benefits of diabetes self3 management training in order to promote better 

4 health outcomes for patients with diabetes. 

5 (2) REPORT.—Not later than 1 year after the 

6 date of the enactment of this Act, the Director of 

7 the Agency for Healthcare Research and Quality 

8 shall submit to Congress a report on the rec9 ommendations developed under paragraph (1). 

10 (e) EFFECTIVE DATE.—The amendments made by 

11 this section shall apply to items and services furnished 

12 after the end of the 12-month period beginning on the date 

13 of the enactment of this Act. 

Æ 


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