II 

117TH CONGRESS 

1ST SESSION S. 3246 

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

of diabetes in Medicare beneficiaries by extending coverage under Medicare for medical nutrition therapy services to such beneficiaries with 

pre-diabetes or with risk factors for developing type 2 diabetes. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 18, 2021 

Mr. PETERS (for himself and Mrs. CAPITO) 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 reduce 

the occurrence of diabetes in Medicare beneficiaries by 

extending coverage under Medicare for medical nutrition 

therapy services to such beneficiaries with pre-diabetes 

or with risk factors for developing type 2 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 ‘‘Preventing Diabetes 

5 in Medicare Act of 2021’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) According to the Centers for Disease Con2 trol and Prevention, there are more than 88,000,000 

3 adults with pre-diabetes in the United States. The 

4 Centers estimates that 27 percent of adults who are 

5 65 years of age or older have pre-diabetes. More 

6 than 83 percent of adults with pre-diabetes do not 

7 know they have it. 

8 (2) For a significant number of people with 

9 pre-diabetes, early intervention can reverse elevated 

10 blood glucose levels to normal range and prevent di11 abetes and its complications completely or can sig12 nificantly delay its onset. According to the Institute 

13 for Alternative Futures, if 50 percent of adults with 

14 pre-diabetes were able to successfully make lifestyle 

15 changes proven to prevent or delay diabetes, then by 

16 2025 approximately 4,700,000 new cases of diabetes 

17 could be prevented at a cost savings of $300 billion. 

18 (3) Preventing diabetes and its complications 

19 can save money and lives. The average annual cost 

20 to treat someone with diabetes is $16,752, which is 

21 2.3 times higher than average costs for someone who 

22 does not have diabetes. The United States spends 

23 $327 billion per year on costs associated with diabe24 tes, with government insurance including Medicare 

covering over 2 25 ⁄3 of these costs. 


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1 (4) Diabetes is unique because its complications 

2 and their associated health care costs are often pre3 ventable with currently available medical treatment 

4 and lifestyle changes. 

5 (5) A recent systematic review conducted by the 

6 Academy of Nutrition and Dietetics Evidence Anal7 ysis Library concluded that randomized clinical 

8 trials involving medical nutrition therapy resulted in 

9 a significant decrease in waist circumference, fasting 

10 blood glucose, and two-hour post prandial blood glu11 cose, which is graded as strong evidence of having 

12 a lower risk of developing type 2 diabetes. A second, 

13 independent systematic review of diabetes prevention 

14 using nutrition therapy conducted in Europe found 

15 that individuals who received the lifestyle interven16 tions had a 47-percent reduced risk of developing 

17 type 2 diabetes. 

18 (6) The Medicare program currently provides 

19 coverage for screening and identifying beneficiaries 

20 with pre-diabetes but does not provide adequate 

21 services to such beneficiaries to help them prevent or 

22 delay the onset of diabetes. 

23 (7) According to the American Diabetes Asso24 ciation, diabetes disproportionately affects racial and 

25 ethnic minority populations. Compared with White 


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1 adults, the risk of having a diabetes diagnosis is 77 

2 percent higher among African Americans, 66 percent 

3 higher among Latino and Hispanic Americans, and 

4 18 percent higher among Asian Americans. 

5 SEC. 3. MEDICARE COVERAGE OF MEDICAL NUTRITION 

6 THERAPY SERVICES FOR PEOPLE WITH PRE7 DIABETES AND RISK FACTORS FOR DEVEL8 OPING TYPE 2 DIABETES. 

9 (a) IN GENERAL.—Section 1861 of the Social Secu10 rity Act (42 U.S.C. 1395x) is amended— 

11 (1) in subsection (s)(2)(V), by striking ‘‘a bene12 ficiary with diabetes or a renal disease’’ and insert13 ing ‘‘an individual with diabetes, pre-diabetes (as de14 fined in subsection (yy)(4)), or a renal disease, or an 

15 individual at risk for diabetes (as defined in sub16 section (yy)(2)),’’ in the matter preceding clause (i); 

17 and 

18 (2) in subsection (yy)— 

19 (A) in the heading, by adding ‘‘; Pre-Dia20 betes’’ at the end; and 

21 (B) by adding at the end the following new 

22 paragraph: 

23 ‘‘(4) The term ‘pre-diabetes’ means a condition of im24 paired fasting glucose or impaired glucose tolerance identiVerDate Sep 11 2014 03:16 Nov 20, 2021 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3246.IS S3246

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1 fied by a blood glucose level that is higher than normal, 

2 but not so high as to indicate actual diabetes.’’. 

3 (b) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply with respect to services furnished 

5 on or after January 1, 2023. 

Æ 


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