II 

108TH CONGRESS 

2D SESSION S. 2431

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

self-management training by designating certified diabetes educators recognized by the National Certification Board of Diabetes Educators as 

certified providers for purposes of outpatient diabetes education services 

under part B of the medicare program. 

IN THE SENATE OF THE UNITED STATES 

MAY 18, 2004

Mr. NELSON of Nebraska (for himself and Mrs. HUTCHISON) 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 improve 

access to diabetes self-management training by designating certified diabetes educators recognized by the National Certification Board of Diabetes Educators as certified providers for purposes of outpatient diabetes education 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 ‘‘Diabetes Self-Manage5 ment Training Act of 2004’’. 
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•S 2431 IS 

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Diabetes is the fifth leading cause of death 

4 in the United States. Over 18,000,000 Americans 

5 (6.2 percent of the population) currently are living 

6 with diabetes, a number that is estimated to increase 

7 to 29,000,000 by the year 2050. In 2002, diabetes 

8 accounted for $132,000,000,000 in direct and indi9 rect health care costs. Diabetes is widely recognized 

10 as one of the top public health threats facing our 

11 Nation today. 

12 (2) Diabetes can occur in 2 forms—type 1 dia13 betes is caused by the body’s inability to produce in14 sulin, a hormone that allows glucose or sugar to 

15 enter and fuel cells and type 2 diabetes, which oc16 curs when the body fails to make enough insulin or 

17 fails to properly use it. People with type 1 diabetes 

18 are required to take daily insulin injections to stay 

19 alive. While some people with type 2 diabetes need 

20 insulin shots, others with type 2 diabetes can control 

21 their diabetes through healthy diet, nutrition, and 

22 lifestyle changes. Type 2 diabetes accounts for up to 

23 95 percent of all diabetes cases affecting 8 percent 

24 of the population age 20 and older. The prevalence 

25 of type 2 diabetes has tripled in the last 30 years, 
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•S 2431 IS 

1 with much of that increase due to an upsurge in 

2 obesity. 

3 (3) In 2002, the Diabetes Prevention Program 

4 study found that participants (all of whom were at 

5 increased risk of developing type 2 diabetes) who 

6 made lifestyle changes reduced their risk of getting 

7 type 2 diabetes by 58 percent. 

8 (4) Diabetes self-management training 

9 (DSMT), also called diabetes education, provides 

10 knowledge and skill training to patients with diabe11 tes, helping them identify barriers, facilitate problem 

12 solving, and develop coping skills to effectively man13 age their diabetes. Unlike many other diseases, dia14 betes requires constant vigilance on the part of the 

15 patient and demands far more than just taking pills 

16 or insulin shots. A certified diabetes educator is a 

17 health care professional—often a nurse, dietitian, or 

18 pharmacist, who specializes in helping people with 

19 diabetes develop the self-management skills needed 

20 to stay healthy and avoid costly acute complications 

21 and emergency care, as well as debilitating sec22 ondary conditions caused by diabetes. 

23 (5) There are currently over 20,000 diabetes 

24 educators in the United States, most of whom are 

25 certified diabetes educators (CDEs) credentialed by 
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•S 2431 IS 

1 the National Certification Board for Diabetes Edu2 cators (NCBDE). To earn a CDE designation, a 

3 health care professional must be licensed or reg4 istered, or have received an advanced degree in a rel5 evant public health concentration, have professional 

6 practice experience and have met minimum hours re7 quirements in diabetes self-management training, 

8 and have met certification and recertification re9 quirements. Many other health care professionals 

10 that are able to bill for diabetes education through 

11 the medicare program have far less experience or 

12 ability to provide the skilled expertise to help people 

13 with diabetes self-manage the disease. 

14 (6) CDEs represent the only group of health 

15 care professionals who provide diabetes self-manage16 ment training that have not been recognized as 

17 health care providers and are therefore precluded 

18 from directly billing the medicare program for 

19 DSMT. Adding CDEs as providers to that program 

20 would give diabetes patients access to the care they 

21 need. 
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•S 2431 IS 

1 SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU2 CATORS AS MEDICARE PROVIDERS FOR PUR3 POSES OF DIABETES OUTPATIENT SELF-MAN4 AGEMENT TRAINING SERVICES. 

5 (a) IN GENERAL.—Section 1861(qq) of the Social Se6 curity Act (42 U.S.C. 1395x(qq)) is amended—

7 (1) in paragraph (2)—

8 (A) in subparagraph (A), by inserting 

9 ‘‘and includes a certified diabetes educator (as 

10 defined in paragraph (3)) who is credentialed 

11 by a nationally recognized certifying body for 

12 diabetes educators and who provides services 

13 within a diabetes self-management training pro14 gram that is lawfully operated under all appli15 cable Federal, State, and local laws and regula16 tions’’ before the semicolon at the end; and 

17 (B) in subparagraph (B), by inserting be18 fore the period at the end the following: ‘‘or is 

19 a certified diabetes educator (as so defined) 

20 who is credentialed by a nationally recognized 

21 certifying body for diabetes educators and who 

22 provides services within a diabetes self-manage23 ment training program that is lawfully operated 

24 under all applicable Federal, State, and local 

25 laws and regulations’’; and 

26 (2) by adding at the end the following: 
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•S 2431 IS 

1 ‘‘(3) For purposes of paragraph (2), the term ‘cer2 tified diabetes educator’ means an individual who—

3 ‘‘(A) is a health care professional who special4 izes in helping individuals with diabetes develop the 

5 self-management skills needed to overcome the daily 

6 challenges and problems caused by the disease; 

7 ‘‘(B) has an advanced degree in a relevant pub8 lic health concentration or is a licensed or registered 

9 health care professional, has met eligibility require10 ments for initial certification, including meeting the 

11 minimum requirements for professional practice ex12 perience and hours for diabetes self-management, 

13 and has passed a certification exam approved by a 

14 nationally recognized certifying body for diabetes 

15 educators; and 

16 ‘‘(C) has periodically renewed certification sta17 tus following initial certification.’’. 

18 (b) GAO STUDY AND REPORT.—

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

20 United States shall conduct a study to identify the 

21 barriers that exist for individuals with diabetes in 

22 accessing diabetes self-management training, includ23 ing economic and geographic barriers and avail24 ability of appropriate referrals and access to ade25 quate, qualified providers. 
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•S 2431 IS 

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

2 date of enactment of this Act, the Comptroller Gen3 eral of the United States shall submit a report to 

4 Congress regarding the study conducted under para5 graph (2). 

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

7 subsection (a) shall apply to diabetes outpatient self-man8 agement training services furnished on or after the date 

9 that is 6 months after the date of enactment of this Act.

Æ