II 

109TH CONGRESS 

1ST SESSION S. 626 

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

self management training by designating certified diabetes educators 

who are recognized by a nationally recognized certifying body and who 

meet the same quality standards set forth for other providers of diabetes 

self management training, as certified providers for purposes of outpatient diabetes self-management training services under part B of the 

medicare program. 

IN THE SENATE OF THE UNITED STATES 

MARCH 15, 2005 

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 who are recognized 

by a nationally recognized certifying body and who meet 

the same quality standards set forth for other providers 

of diabetes self management training, as certified providers for purposes of outpatient diabetes self-management training 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, 
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Diabetes Self Manage3 ment Training Act of 2005’’. 

4 SEC. 2. FINDINGS. 

5 Congress makes the following findings: 

6 (1) Diabetes is widely recognized as one of the 

7 top public health threats facing our Nation today. 

8 More than 18,000,000 Americans are currently liv9 ing with diabetes and that number is expected to 

10 double by the year 2050. Diabetes is the sixth lead11 ing cause of death in the United States, causing 

12 more than 200,000 deaths each year. 

13 (2) Diabetes occurs in two forms. Type 1 diabe14 tes is caused by the body’s inability to produce insu15 lin, a hormone that allows glucose to enter and fuel 

16 cells. Type 2 diabetes occurs when the body fails to 

17 make enough insulin or fails to properly use it. Type 

18 1 diabetes typically develops in childhood or adoles19 cence and accounts for only 5 to 10 percent of cases 

20 of diabetes. Type 2 diabetes accounts for 90 to 95 

21 percent of diabetes cases and most often appears 

22 among people older than 40. It is especially common 

23 in the medicare population, as 1 in 5 adults over age 

24 65 has type 2 diabetes. 

25 (3) Diabetes is a costly disease. In 2002, diabe26 tes accounted for $132,000,000,000 in direct and in-
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1 direct health care costs. It is especially costly for the 

2 medicare program. Individuals with diabetes rep3 resent approximately 20 percent of medicare bene4 ficiaries but account for more than 30 percent of 

5 fee-for-service medicare expenditures. 

6 (4) People with type 1 diabetes are required to 

7 take daily insulin injections to stay alive. While some 

8 people with type 2 diabetes need daily insulin injec9 tions, others with type 2 diabetes can control their 

10 diabetes through healthy meal plans, exercise, and, 

11 for some, oral medications. Diabetes self manage12 ment training (in this section referred to as 

13 ‘‘DSMT’’), also called diabetes education, provides 

14 knowledge and skills training to patients with diabe15 tes, helping them identify barriers, facilitate problem 

16 solving, and develop coping skills to effectively man17 age their diabetes. A certified diabetes educator is a 

18 health care professional, often a nurse, dietitian, or 

19 pharmacist, who specializes in helping people with 

20 diabetes develop the self-management skills needed 

21 to stay healthy and avoid costly acute complications 

22 and emergency care, as well as debilitating sec23 ondary conditions caused by diabetes. 

24 (5) DSMT has been proven effective in helping 

25 to reduce the risks and complications of diabetes. In 
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1 2002, the Diabetes Prevention Program study found 

2 that participants (all of whom were at increased risk 

3 of developing type 2 diabetes) who made lifestyle 

4 changes, such as those taught in DSMT programs, 

5 reduced their risk of getting type 2 diabetes by 58 

6 percent. Lifestyle intervention worked in all of the 

7 groups but it worked particularly well in people aged 

8 60 and older, reducing the development of diabetes 

9 by 71 percent. Similarly, studies have found that pa10 tients under the care of a certified diabetes educator 

11 are better able to control their diabetes and report 

12 improvement in their health status. Congress recog13 nized the value of DSMT by creating medicare cov14 erage for this benefit under the Balanced Budget 

15 Act of 1997. 

16 (6) There are currently more than 20,000 dia17 betes educators in the United States, most of whom 

18 are certified diabetes educators credentialed by the 

19 National Certification Board for Diabetes Educators 

20 (NCBDE). Eligibility for certification as a diabetes 

21 educator requires prerequisite qualifying professional 

22 credentials in specified health care professions and 

23 professional practice experience that includes a min24 imum number of hours of experience in DSMT. Cer25 tified diabetes educators must also pass a rigorous 
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1 national examination and periodically renew their 

2 credentials. Certified diabetes educators are uniquely 

3 qualified to provide DSMT under the medicare pro4 gram. 

5 SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU6 CATORS AS MEDICARE PROVIDERS FOR PUR7 POSES OF DIABETES OUTPATIENT SELF-MAN8 AGEMENT TRAINING SERVICES. 

9 (a) IN GENERAL.—Section 1861(qq) of the Social Se10 curity Act (42 U.S.C. 1395x(qq)) is amended— 

11 (1) in paragraph (2)— 

12 (A) in subparagraph (A), by inserting ‘‘, or 

13 a certified diabetes educator (as defined in 

14 paragraph (3)) who is credentialed by a nation15 ally recognized certifying body for diabetes edu16 cators’’ before the semicolon at the end; and 

17 (B) in subparagraph (B), by striking ‘‘a 

18 physician’’ through ‘‘meets applicable’’ and in19 serting the following: ‘‘a physician, or such 

20 other individual or entity, or a certified diabetes 

21 educator meets the quality standards described 

22 in this paragraph if the physician, other indi23 vidual or entity, or certified diabetes educator 

24 meets quality standards established by the Sec25 retary, except that the physician, other indi-
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1 vidual or entity, or certified diabetes educator 

2 shall be deemed to have met such standards if 

3 the physician, other individual or entity, or cer4 tified diabetes educator meets applicable’’; and 

5 (2) by adding at the end the following new 

6 paragraph: 

7 ‘‘(3) For purposes of paragraph (2), the term ‘‘cer8 tified diabetes educator’ means an individual who— 

9 ‘‘(A) is a health care professional who special10 izes in helping individuals with diabetes develop the 

11 self-management skills needed to overcome the daily 

12 challenges and problems caused by the disease; 

13 ‘‘(B) has met all criteria for initial certification, 

14 including a prerequisite qualifying professional cre15 dential in a specified health care profession, has pro16 fessional practice experience in diabetes self-manage17 ment training that includes a minimum number of 

18 hours of diabetes self-management training, and has 

19 passed a national examination offered by a certifying 

20 body recognized as entitled to grant certification to 

21 diabetes educators; and 

22 ‘‘(C) has periodically renewed certification sta23 tus following initial certification.’’. 

24 (b) GAO STUDY AND REPORT.— 
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1 (1) STUDY.—The Comptroller General of the 

2 United States shall conduct a study to identify the 

3 barriers that exist for individuals with diabetes in 

4 accessing diabetes self management training, includ5 ing economic and geographic barriers and avail6 ability of appropriate referrals and access to ade7 quate, qualified providers. 

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

9 date of enactment of this Act, the Comptroller Gen10 eral of the United States shall submit a report to 

11 Congress regarding the study conducted under para12 graph (1). 

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

14 subsection (a) shall apply to diabetes outpatient self-man15 agement training services furnished on or after the date 

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

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