I

105TH CONGRESS

1ST SESSION H. R. 58

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

JANUARY 7, 1997

Ms. FURSE (for herself, Mr. NETHERCUTT, Mr. DINGELL, Mr. BEREUTER,

Mr. BOUCHER, Mr. DAVIS of Virginia, Mr. DEAL of Georgia, Mr. WAXMAN, Mr. WYNN, Mr. SKEEN, Mr. SAWYER, Mr. RUSH, Ms. ESHOO, Mr.

NEY, Mr. RAMSTAD, Mrs. KENNELLY of Connecticut, Mr. GREEN, Mr.

BROWN of Ohio, Mr. PALLONE, Ms. PRYCE of Ohio, Mr. POMEROY, Mr.

SERRANO, Mr. ENGEL, Mr. MARKEY, Mr. MANTON, Mr. WATTS of Oklahoma, Mr. STUPAK, Mr. STARK, Mr. TOWNS, Mr. GORDON, Mrs.

MORELLA, Mr. KLINK, Mr. CONDIT, Mr. DEUTSCH, Mrs. MYRICK, Ms.

SLAUGHTER, Mr. MCKEON, Mr. HALL of Ohio, Mr. HAMILTON, Ms.

EDDIE BERNICE JOHNSON of Texas, Mr. BARRETT of Wisconsin, Mr.

KILDEE, Mr. ACKERMAN, Mr. YATES, Mr. WOLF, Mr. ANDREWS, Mr.

BALDACCI, Mr. PETRI, Mr. BLUMENAUER, Mr. BONIOR, Ms. PELOSI, Mr.

SCHIFF, Mr. WATT of North Carolina, Mr. UNDERWOOD, Mr. CARDIN,

Mr. CLAY, Ms. DELAURO, Mr. FAZIO of California, Mr. LAFALCE, Mrs.

MALONEY of New York, Mrs. MINK of Hawaii, Mr. RAHALL, Mr. SABO,

Mr. MARTINEZ, Mr. MASCARA, Mr. GEPHARDT, Mr. GEJDENSON, Mr.

WAMP, Mr. DEFAZIO, and Ms. HOOLEY) 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
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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,

3 SECTION 1. SHORT TITLE.

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

5 Education and Supplies Amendments of 1997’’.

6 SEC. 2. MEDICARE COVERAGE OF DIABETES OUTPATIENT

7 SELF-MANAGEMENT TRAINING SERVICES.

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

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

10 (1) by striking ‘‘and’’ at the end of subpara11 graphs (M) and (O), and

12 (2) by inserting after subparagraph (O) the fol13 lowing new subparagraph:

14 ‘‘(P) diabetes outpatient self-management train15 ing services (as defined in subsection (oo)); and’’.

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

17 U.S.C. 1395x) is amended by adding at the end the follow18 ing new subsection:

19 ‘‘Diabetes Outpatient Self-management Training Services

20 ‘‘(oo)(1) The term ‘diabetes outpatient self-manage21 ment training services’ means educational and training

22 services furnished to an individual with diabetes by or

23 under arrangements with a certified provider (as described
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1 in paragraph (2)(A)) in an outpatient setting by an indi2 vidual or entity who meets the quality standards described

3 in paragraph (2)(B), but only if the physician who is man4 aging the individual’s diabetic condition certifies that such

5 services are needed under a comprehensive plan of care

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

7 individual with necessary skills and knowledge (including

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

9 to participate in the management of the individual’s condi10 tion.

11 ‘‘(2) In paragraph (1)—

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

13 entity that, in addition to providing diabetes out14 patient self-management training services, provides

15 other items or services for which payment may be

16 made under this title; and

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

18 standards described in this paragraph if the individ19 ual or entity meets quality standards established by

20 the Secretary, except that the individual or entity

21 shall be deemed to have met such standards if the

22 individual or entity meets applicable standards origi23 nally established by the National Diabetes Advisory

24 Board and subsequently revised by organizations

25 who participated in the establishment of standards
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1 by such Board, or is recognized by the American Di2 abetes Association as meeting standards for furnish3 ing the services.’’.

4 (c) CONSULTATION WITH ORGANIZATIONS IN ESTAB5 LISHING PAYMENT AMOUNTS FOR SERVICES PROVIDED

6 BY PHYSICIANS.—In establishing payment amounts under

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

8 services consisting of diabetes outpatient self-management

9 training services, the Secretary of Health and Human

10 Services shall consult with appropriate organizations, in11 cluding the American Diabetes Association, in determining

12 the relative value for such services under section

13 1848(c)(2) of such Act.

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

15 this section shall apply to services furnished on or after

16 January 1, 1998.

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

18 FOR INDIVIDUALS WITH DIABETES.

19 (a) INCLUDING STRIPS AS DURABLE MEDICAL

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

21 (42 U.S.C. 1395x(n)) is amended by striking the semi22 colon in the first sentence and inserting the following: ‘‘,

23 and includes blood-testing strips for individuals with dia24 betes without regard to injection of insulin (as determined
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1 under standards established by the Secretary in consulta2 tion with the American Diabetes Association);’’.

3 (b) PAYMENT FOR STRIPS BASED ON METHODOLOGY

4 FOR INEXPENSIVE AND ROUTINELY PURCHASED EQUIP5 MENT.—Section 1834(a)(2)(A) of such Act (42 U.S.C.

6 1395m(a)(2)(A)) is amended—

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

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

9 and

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

11 new clause:

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

13 an individual with diabetes,’’.

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

15 this section shall apply to blood-testing strips furnished

16 on or after January 1, 1998.

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