I 

115TH CONGRESS 

2D SESSION H. R. 5768 

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

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

IN THE HOUSE OF REPRESENTATIVES 

MAY 10, 2018 

Mr. REED (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 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 2018’’ or the 

6 ‘‘Expanding Access to DSMT Act of 2018’’. 


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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 paragraphs: 

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 described in paragraph (1), to re26 main available until used. 


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1 ‘‘(B) Six additional hours (or a greater number 

2 of hours if determined appropriate by the Secretary) 

3 of such services during the year in which the indi4 vidual exhausts the initial hours described in sub5 paragraph (A), provided that the physician or quali6 fied nonphysician practitioner who is managing the 

7 individual’s diabetic condition (or other physician or 

8 qualified nonphysician practitioner furnishing items 

9 or services to such individual, in coordination with 

10 the physician or qualified nonphysician practitioner 

11 managing such individual’s diabetic condition) cer12 tifies the medical necessity of such additional hours. 

13 ‘‘(C) Six additional hours (or a greater number 

14 of hours if determined appropriate by the Secretary) 

15 of such services per year for each year beginning 

16 after the year in which the individual exhausts the 

17 initial hours described in subparagraph (A), provided 

18 that the physician or qualified nonphysician practi19 tioner who is managing the individual’s diabetic con20 dition (or other physician or qualified nonphysician 

21 practitioner furnishing items or services to such in22 dividual, in coordination with the physician or quali23 fied nonphysician practitioner managing such indi24 vidual’s diabetic condition) certifies the medical ne25 cessity of such additional hours. 


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1 ‘‘(D) For a year in which the individual has re2 ceived additional hours described in subparagraph 

3 (B) or (C) and exhausted such hours, an additional 

4 number of hours determined appropriate by the phy5 sician or qualified nonphysician practitioner who is 

6 managing the individual’s diabetic condition (or 

7 other physician or qualified nonphysician practi8 tioner furnishing items or services to such indi9 vidual, in coordination with the physician or quali10 fied nonphysician practitioner managing such indi11 vidual’s diabetic condition), provided that the physi12 cian or qualified nonphysician practitioner who is 

13 managing the individual’s diabetic condition (or 

14 other physician or qualified nonphysician practi15 tioner furnishing items or services to such indi16 vidual, in coordination with the physician or quali17 fied nonphysician practitioner managing such indi18 vidual’s diabetic condition) certifies that— 

19 ‘‘(i) there has been a change in the individ20 ual’s diagnosis, medical condition, or treatment 

21 regimen; 

22 ‘‘(ii) the individual is not meeting appro23 priate clinical outcomes (as determined by such 

24 physician or qualified nonphysician practitioner) 

25 for such condition; or 


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1 ‘‘(iii) the individual meets other criteria 

2 that necessitates such additional number of 

3 hours, as determined by the Secretary. 

4 ‘‘(4) For purposes of this section, the term ‘qualified 

5 nonphysician practitioner’ means a physician assistant, 

6 nurse practitioner, or clinical nurse specialist (as defined 

7 in section 1861(aa)(5)).’’. 

8 (b) MEDICAL NUTRITION THERAPY SERVICES.—Sec9 tion 1861(s)(2)(V) of such Act (42 U.S.C. 

10 1395x(s)(2)(V)) is amended— 

11 (1) by striking clause (i); 

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

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

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

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

16 with’’. 

17 (c) COST-SHARING.—Section 1833 of such Act (42 

18 U.S.C. 1395l) is amended— 

19 (1) in subsection (a)(1)— 

20 (A) by striking ‘‘and (BB)’’ and inserting 

21 ‘‘(BB)’’; and 

22 (B) by striking the semicolon at the end 

23 and inserting ‘‘, and (CC) with respect to diabe24 tes outpatient self-management training serv25 ices (as defined in section 1861(qq)), the 


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1 amount paid shall be 100 percent of the lesser 

2 of the actual charge for the services or the 

3 amount determined under the fee schedule that 

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

5 (2) in subsection (b)— 

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

7 ‘‘(10)’’; and 

8 (B) by striking ‘‘1861(hhh)(1)).’’ and in9 serting ‘‘1861(hhh)(1)), and (11) such deduct10 ible shall not apply with respect to diabetes out11 patient self-management training services (as 

12 defined in section 1861(qq)).’’ 

13 (d) REVISION OF MANUAL.—Not later than 180 days 

14 after the date of the enactment of this Act, the Secretary 

15 of Health and Human Services shall revise the Medicare 

16 Benefit Policy Manual to ensure that diabetes outpatient 

17 self-management training services (as defined in section 

18 1861(qq) of the Social Security Act (42 U.S.C. 

19 1395x(qq)), as amended by subsection (a)) may be fur20 nished by an entity that is a hospital outpatient depart21 ment at alternate, nonhospital sites (including community22 based locations). 

23 (e) APPLICATION.—The amendments made by this 

24 section shall apply with respect to items and services fur25 nished on or after January 1, 2019. 


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1 SEC. 3. VIRTUAL DIABETES OUTPATIENT SELF-MANAGE2 MENT TRAINING SERVICES DEMONSTRATION 

3 PROGRAM. 

4 (a) IN GENERAL.—Beginning not later than January 

5 1, 2019, the Secretary of Health and Human Services (in 

6 this section referred to as the ‘‘Secretary’’) shall select an 

7 appropriate number of applicable beneficiaries to partici8 pate in a 2-year demonstration program to test the impact 

9 of furnishing diabetes outpatient self-management train10 ing services through a qualified online platform with re11 spect to cost and clinical outcomes for such applicable 

12 beneficiaries. Under such program, diabetes outpatient 

13 self-management training services furnished through a 

14 qualified online platform to an applicable beneficiary shall 

15 be covered under title XVIII of the Social Security Act, 

16 and payment for such services shall be made in the same 

17 manner as payment is made under such title for such serv18 ices furnished in an outpatient setting. 

19 (b) DEFINITIONS.—In this section: 

20 (1) APPLICABLE BENEFICIARY.—The term ‘‘ap21 plicable beneficiary’’ means an individual— 

22 (A) who is enrolled under part B of title 

23 XVIII of the Social Security Act; 

24 (B) who has a diagnosis of diabetes; and 

25 (C) who agrees to take part in the dem26 onstration program described in subsection (a). 


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1 (2) QUALIFIED ONLINE PLATFORM.—The term 

2 ‘‘qualified online platform’’ means an online-based 

3 platform— 

4 (A) designed to furnish educational and 

5 training services to an individual with diabetes 

6 to ensure therapy compliance with respect to 

7 the individual’s diabetic condition or to provide 

8 the individual with necessary skills and knowl9 edge (including skills related to the self-admin10 istration of injectable drugs) to participate in 

11 the individual’s management of such condition; 

12 and 

13 (B) that meets the National Standards for 

14 Diabetes Self-Management Education and Sup15 port, as jointly published by the American Asso16 ciation of Diabetes Educators and the American 

17 Diabetes Association. 

18 (3) DIABETES SELF-MANAGEMENT TRAINING

19 SERVICES.—The term ‘‘diabetes outpatient self-man20 agement training services’’ has the meaning given 

21 such term in section 1861(qq) of the Social Security 

22 Act (42 U.S.C. 1395x(qq)) except that the require23 ment in paragraph (1) of such section with respect 

24 to such services being furnished in an outpatient set25 ting shall not apply. 


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1 (c) EVALUATION.—The Secretary shall evaluate the 

2 demonstration program described in subsection (a) based 

3 on the following criteria: 

4 (1) The improvement, if any, in health out5 comes with respect to the diabetic conditions of ap6 plicable beneficiaries participating in such program 

7 as evidenced by— 

8 (A) any improvement attributable to such 

9 program in the knowledge of such beneficiaries 

10 with respect to such conditions; 

11 (B) any behavioral changes attributable to 

12 such program; 

13 (C) any clinical outcome improvements at14 tributable to such program; 

15 (D) any quality of life improvements at16 tributable to such program; and 

17 (E) the overall satisfaction of such bene18 ficiaries with such program. 

19 (2) Reductions, if any, in expenditures under 

20 title XVIII of the Social Security Act attributable to 

21 such program. 

22 (3) Other criteria determined appropriate by 

23 the Secretary. 

24 (d) REPORT.—Not later than 18 months after the 

25 date of the completion of the demonstration program deVerDate Sep 11 2014 03:15 May 30, 2018 Jkt 079200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5768.IH H5768

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1 scribed in subsection (a), the Secretary shall submit to 

2 Congress a report containing— 

3 (1) the results of the evaluation described in 

4 subsection (c); 

5 (2) an analysis of the demographic characteris6 tics of applicable beneficiaries who participated in 

7 such program; and 

8 (3) a recommendation on whether such program 

9 should be continued or expanded. 

10 (e) WAIVER AUTHORITY.—The Secretary may waive 

11 such requirements of titles XI and XVIII of the Social 

12 Security Act (42 U.S.C. 1301 et seq., 1395 et seq.) as 

13 may be necessary to carry out the provisions of this sec14 tion. 

15 (f) AUTHORITY TO EXPAND DEMONSTRATION PRO16 GRAM.—Notwithstanding subsection (a), taking into ac17 count the evaluation described in subsection (c), the Sec18 retary may, through rulemaking, expand the duration and 

19 the scope of the demonstration program described in sub20 section (a), to the extent determined appropriate by the 

21 Secretary, if— 

22 (1) the Secretary determines that such expan23 sion is expected to— 


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1 (A) reduce spending under title XVIII of 

2 the Social Security Act without reducing quality 

3 of care; or 

4 (B) improve the quality of care for individ5 uals enrolled under part B of such title without 

6 increasing spending under such title; 

7 (2) the Chief Actuary of the Centers for Medi8 care & Medicaid Services certifies that such expan9 sion would reduce (or would not result in any in10 crease in) net program spending under such title; 

11 and 

12 (3) the Secretary determines that such expan13 sion would not deny or limit the coverage or provi14 sion of benefits under such title for individuals en15 rolled under part B of such title. 

Æ 


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