II 

111TH CONGRESS 

2D SESSION S. 3211 

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

self-management training by designating certain certified diabetes educators as certified providers for purposes of outpatient diabetes selfmanagement training services under part B of the Medicare Program. 

IN THE SENATE OF THE UNITED STATES 

APRIL 15, 2010 

Mrs. SHAHEEN (for herself, Ms. STABENOW, Mrs. HAGAN, and Mr. FRANKEN) 

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 certain certified diabetes educators 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, 

3 SECTION 1. SHORT TITLE. 

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

5 Self-Management Training Act of 2010’’. 


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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

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

4 top public health threats currently facing the United 

5 States. According to the Centers for Disease Control 

6 and Prevention, approximately 24,000,000 people in 

7 the United States are currently living with diabetes, 

8 and another 57,000,000 people in the United States 

9 have pre-diabetes, dramatically raising their risk of 

10 developing diabetes, heart disease, and stroke. Three 

11 million individuals with diagnosed diabetes receive 

12 no treatment for the disease, and only about 56 per13 cent of those newly diagnosed with diabetes receive 

14 the type of diet and exercise counseling that are vital 

15 components of a diabetes self management training 

16 (DSMT) regimen. The number of Americans living 

17 with diabetes increased 50 percent between 1997– 

18 2004, and the Centers for Disease Control projects 

19 that the prevalence of diagnosed diabetes in the U.S. 

20 will increase 165 percent by 2050. 

21 (2) The American Diabetes Association esti22 mates that diabetes costs the United States over 

23 $174 billion annually, with $116 billion attributed to 

24 direct medical costs associated with diabetes care, 

25 and $58 billion attributed to indirect costs associ26 ated with lost productivity. Eighteen percent of all 


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1 Medicare beneficiaries have diabetes, accounting for 

2 32 percent of Medicare spending. 

3 (3) Diabetes self-management training, also 

4 called diabetes education, provides critical knowledge 

5 and skills training to patients with diabetes, helping 

6 them identify barriers, facilitate problem solving, 

7 and develop coping skills to effectively manage their 

8 diabetes. A certified diabetes educator is a health 

9 care professional, often a nurse, dietitian, or phar10 macist, who specializes in helping people with diabe11 tes develop the self-management skills needed to 

12 stay healthy and avoid costly acute complications 

13 and emergency care, as well as debilitating sec14 ondary conditions caused by diabetes. 

15 (4) Diabetes self-management training has been 

16 proven effective in helping to reduce the risks and 

17 complications of diabetes. In 2002, the Diabetes 

18 Prevention Program study conducted by the Na19 tional Institutes of Health and the Centers for Dis20 ease Control and Prevention found that participants 

21 (all of whom were at increased risk of developing 

22 type 2 diabetes) who made lifestyle changes reduced 

23 their risk of getting type 2 diabetes by 58 percent. 

24 Lifestyle intervention worked in all of the groups but 

25 it worked particularly well in people aged 60 and 


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1 older, reducing the development of diabetes by 71 

2 percent. Similarly, studies have found that patients 

3 under the care of a certified diabetes educator are 

4 better able to control their diabetes and report im5 provement in their health status. 

6 (5) Lifestyle changes, such as those taught by 

7 certified diabetes educators, directly contribute to 

8 better glycemic control and reduced complications 

9 from diabetes. Evidence shows that the potential for 

10 prevention of the most serious medical complications 

11 caused by diabetes to be as high as 90 percent 

12 (blindness), 85 percent (amputations), and 50 per13 cent (heart disease and stroke) with proper medical 

14 treatment and active self-management. 

15 (6) There are currently more than 20,000 dia16 betes educators in the United States, most of whom 

17 are certified diabetes educators credentialed by the 

18 National Certification Board for Diabetes Edu19 cators. Eligibility for certification as a diabetes edu20 cator by the National Certification Board for Diabe21 tes Educators requires prerequisite qualifying pro22 fessional credentials in specific health care profes23 sions and professional practice experience that in24 cludes a minimum number of hours and years of ex25 perience in diabetes self-management training. DiaVerDate Nov 24 2008 04:26 Apr 16, 2010 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3211.IS S3211

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1 betes educators certified by the National Certifi2 cation Board for Diabetes Educators must also pass 

3 a rigorous national examination and periodically 

4 renew their credentials. Diabetes educators certified 

5 by the National Certification Board for Diabetes 

6 Educators, and licensed by a State as a health pro7 fessional, are uniquely qualified to provide diabetes 

8 self-management training under the Medicare pro9 gram. 

10 (7) Enhancing access to diabetes self-manage11 ment training programs that are taught by Certified 

12 Diabetes Educators is an important public policy 

13 goal that can help improve health outcomes, ensure 

14 quality, and reduce escalating diabetes-related health 

15 costs. 

16 SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU17 CATORS AS CERTIFIED PROVIDERS FOR PUR18 POSES OF MEDICARE DIABETES OUTPATIENT 

19 SELF-MANAGEMENT TRAINING SERVICES. 

20 (a) IN GENERAL.—Section 1861(qq) of the Social Se21 curity Act (42 U.S.C. 1395x(qq)) is amended— 

22 (1) in paragraph (1), by inserting ‘‘or by a cer23 tified diabetes educator (as defined in paragraph 

24 (3))’’ after ‘‘paragraph (2)(B)’’; and 


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

2 paragraphs: 

3 ‘‘(3) For purposes of paragraph (1), the term 

4 ‘certified diabetes educator’ means an individual 

5 who— 

6 ‘‘(A) is licensed or registered by the State 

7 in which the services are performed as a health 

8 care professional; 

9 ‘‘(B) specializes in teaching individuals 

10 with diabetes to develop the necessary skills and 

11 knowledge to manage the individual’s diabetic 

12 condition; and 

13 ‘‘(C) is certified as a diabetes educator by 

14 a recognized certifying body (as defined in 

15 paragraph (4)). 

16 ‘‘(4)(A) For purposes of paragraph (3)(C), the 

17 term ‘recognized certifying body’ means— 

18 ‘‘(i) the National Certification Board 

19 for Diabetes Educators; or 

20 ‘‘(ii) a certifying body for diabetes 

21 educators, which is recognized by the Sec22 retary as authorized to grant certification 

23 of diabetes educators for purposes of this 

24 subsection pursuant to standards estab25 lished by the Secretary; 


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1 if the Secretary determines such Board or body, 

2 respectively, meets the requirement of subpara3 graph (B). 

4 ‘‘(B) The National Certification Board for 

5 Diabetes Educators or a certifying body for dia6 betes educators meets the requirement of this 

7 subparagraph, with respect to the certification 

8 of an individual, if the Board or body, respec9 tively, is incorporated and registered to do busi10 ness in the United States and requires as a 

11 condition of such certification each of the fol12 lowing: 

13 ‘‘(i) The individual has a qualifying 

14 credential in a specified health care profes15 sion. 

16 ‘‘(ii) The individual has professional 

17 practice experience in diabetes self-man18 agement training that includes a minimum 

19 number of hours and years of experience in 

20 such training. 

21 ‘‘(iii) The individual has successfully 

22 completed a national certification examina23 tion offered by such entity. 


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1 ‘‘(iv) The individual periodically re2 news certification status following initial 

3 certification.’’. 

4 (b) GAO STUDY AND REPORT.— 

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

6 United States shall conduct a study to identify the 

7 barriers that exist for Medicare beneficiaries with di8 abetes in accessing diabetes self-management train9 ing services under the Medicare program, including 

10 economic and geographic barriers and availability of 

11 appropriate referrals and access to adequate and 

12 qualified providers. 

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

14 date of the enactment of this Act, the Comptroller 

15 General of the United States shall submit to Con16 gress a report on the study conducted under para17 graph (1). 

18 (c) AHRQ DEVELOPMENT OF RECOMMENDATIONS

19 FOR OUTREACH METHODS AND REPORT.— 

20 (1) DEVELOPMENT OF RECOMMENDATIONS.— 

21 The Director of the Agency for Healthcare Research 

22 and Quality shall, through use of a workshop and 

23 other appropriate means, develop a series of rec24 ommendations on effective outreach methods to edu25 cate primary care physicians and the public about 


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1 the benefits of diabetes self-management training in 

2 order to promote better health outcomes for patients 

3 with diabetes. 

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

5 date of the enactment of this Act, the Director of 

6 the Agency for Healthcare Research and Quality 

7 shall submit to Congress a report on the rec8 ommendations developed under paragraph (1). 

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

10 subsection (a) shall apply to diabetes outpatient self-man11 agement training services furnished on or after the first 

12 day of the first calendar year that is at least 6 months 

13 after the date of the enactment of this Act. 

Æ 


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