I

104TH CONGRESS

2D SESSION H. R. 4264

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 HOUSE OF REPRESENTATIVES

SEPTEMBER 27, 1996

Mr. NETHERCUTT (for himself, Mr. WELDON of Pennsylvania, Mr. GINGRICH,

Mr. WATTS of Oklahoma, Mr. BONILLA, and Mr. BILIRAKIS) introduced

the following bill; which was referred to the Committee on 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

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,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Medicare Diabetes

3 Education and Treatment Amendments of 1996’’.

4 SEC. 2. MEDICARE COVERAGE OF DIABETES OUTPATIENT

5 SELF-MANAGEMENT TRAINING SERVICES.

6 (a) IN GENERAL.—Section 1861(s)(2) of the Social

7 Security Act (42 U.S.C. 1395x(s)(2)) is amended—

8 (1) by striking ‘‘and’’ at the end of subpara9 graphs (M) and (O), and

10 (2) by inserting after subparagraph (O) the fol11 lowing new subparagraph:

12 ‘‘(R) diabetes outpatient self-management

13 training services (as defined in subsection (oo));

14 and’’.

15 (b) DEFINITION.—Section 1861 of such Act (42

16 U.S.C. 1395x) is amended by adding at the end the follow17 ing new subsection:

18 ‘‘Diabetes Outpatient Self-management Training Services

19 ‘‘(oo)(1) The term ‘diabetes outpatient self-manage20 ment training services’ means educational and training

21 services furnished to an individual with diabetes by or

22 under arrangements with a certified provider (as described

23 in paragraph (2)(A)) in an outpatient setting by an indi24 vidual or entity who meets the quality standards described

25 in paragraph (2)(B), but only if the physician who is man26 aging the individual’s diabetic condition certifies that such
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1 services are needed under a comprehensive plan of care

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

3 individual with necessary skills and knowledge (including

4 skills related to the self-administration of injectable drugs)

5 to participate in the management of the individual’s condi6 tion.

7 ‘‘(2) In paragraph (1)—

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

9 entity that, in addition to providing diabetes out10 patient self-management training services, provides

11 other items or services for which payment may be

12 made under this title; and

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

14 standards described in this paragraph if the individ15 ual or entity meets quality standards established by

16 the Secretary, except that the individual or entity

17 shall be deemed to have met such standards if the

18 individual or entity meets applicable standards origi19 nally established by the National Diabetes Advisory

20 Board and subsequently revised by organizations

21 who participated in the establishment of standards

22 by such Board, or is recognized by the American Di23 abetes Association as meeting standards for furnish24 ing the services.’’.
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1 (c) CONSULTATION WITH ORGANIZATIONS IN ESTAB2 LISHING PAYMENT AMOUNTS FOR SERVICES PROVIDED

3 BY PHYSICIANS.—In establishing payment amounts under

4 section 1848(a) of the Social Security Act for physicians’

5 services consisting of diabetes outpatient self-management

6 training services, the Secretary of Health and Human

7 Services shall consult with appropriate organizations, in8 cluding the American Diabetes Association, in determining

9 the relative value for such services under section

10 1848(c)(2) of such Act.

11 (d) EFFECTIVE DATE.—The amendments made by

12 this section shall apply to services furnished on or after

13 January 1, 1997.

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

15 FOR INDIVIDUALS WITH DIABETES.

16 (a) INCLUDING STRIPS AS DURABLE MEDICAL

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

18 (42 U.S.C. 1395x(n)) is amended by striking the semi19 colon in the first sentence and inserting the following: ‘‘,

20 and includes blood-testing strips for individuals with dia21 betes without regard to whether the individual has Type

22 I or Type II diabetes (as determined under standards es23 tablished by the Secretary in consultation with the Amer24 ican Diabetes Association);’’.
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1 (b) PAYMENT FOR STRIPS BASED ON METHODOLOGY

2 FOR INEXPENSIVE AND ROUTINELY PURCHASED EQUIP3 MENT.—Section 1834(a)(2)(A) of such Act (42 U.S.C.

4 1395m(a)(2)(A)) is amended—

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

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

7 and

8 (3) by inserting after clause (iii) the following

9 new clause:

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

11 an individual with diabetes,’’.

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

13 this section shall apply to blood-testing strips furnished

14 on or after July 1, 1997.

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