II 

114TH CONGRESS 

1ST SESSION S. 586 

To amend the Public Health Service Act to foster more effective implementation and coordination of clinical care for people with pre-diabetes, diabetes, and the chronic diseases and conditions that result from diabetes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 26, 2015 

Mrs. SHAHEEN (for herself, Ms. COLLINS, Mr. BROWN, Mr. MARKEY, Mr. 

KIRK, Ms. AYOTTE, Mrs. BOXER, Mr. NELSON, Mr. DONNELLY, Mr. 

CARPER, Mr. BOOKER, Mr. GRASSLEY, and Mr. PETERS) introduced the 

following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to foster more 

effective implementation and coordination of clinical care 

for people with pre-diabetes, diabetes, and the chronic 

diseases and conditions that result from 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 ‘‘National Diabetes 

5 Clinical Care Commission Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) The Centers for Disease Control and Pre2 vention report that nearly 29,000,000 Americans 

3 have diabetes in addition to an estimated 

4 86,000,000 American adults that have pre-diabetes, 

5 an increase of 3,000,000 Americans with diabetes 

6 and 7,000,000 American adults with pre-diabetes 

7 since 2011. 

8 (2) Diabetes affects 9.3 percent of Americans of 

9 all ages and 12.3 percent of adults age 20 and older. 

10 Adults age 20 and older of racial and ethnic minori11 ties continue to have higher rates of diabetes than 

12 individuals not of such minorities, as demonstrated 

13 by the following: 15.9 percent of all adult American 

14 Indians and Alaskan Natives have diabetes; 13.2 

15 percent of all adult African-Americans have diabetes; 

16 12.8 percent of all adult Hispanics have diabetes; 

17 and 9.0 percent of all adult Asian-Americans have 

18 diabetes, while 7.6 percent of all non-Hispanic 

19 Whites have diabetes. 

20 (3) Diabetes is the seventh leading cause of 

21 death in the United States. 

22 (4) People with diabetes are more likely than 

23 people without diabetes to also have chronic diseases 

24 and conditions that are complications of diabetes, in25 cluding cardiovascular disease, strokes, high blood 


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1 pressure, kidney disease, including dialysis, blind2 ness, neuropathy, and leg and feet amputations. 

3 (5) Adults with diabetes have an elevated risk 

4 of heart disease and stroke. Adults with diabetes 

5 have death rates from heart disease that are nearly 

6 twice as high as adults without the disease. 

7 (6) Diabetes is the leading cause of kidney fail8 ure. Each year, nearly 100,000 individuals in the 

9 United States are diagnosed with kidney failure, and 

10 diabetes accounts for 44 percent of these new cases. 

11 (7) Diabetic neuropathies are a family of nerve 

12 disorders caused by diabetes and are prevalent in 

13 nearly 60 to 70 percent of individuals with diabetes. 

14 (8) Diabetes is the leading cause of new cases 

15 of blindness among adults aged 20 to 74. 

16 (9) About 60 percent of all non-traumatic lower 

17 limb amputations in the United States occur in indi18 viduals with diabetes. 

19 (10) Total national costs associated with diabe20 tes in 2012 exceeded $245,000,000,000, according 

21 to the Centers for Disease Control and Prevention. 

22 (11) One in three Medicare dollars is currently 

23 spent on people with diabetes. 

24 (12) The Centers for Disease Control and Pre25 vention projects that as many as 1 in 3 American 


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1 adults could have diabetes by 2050 if current trends 

2 continue. 

3 (13) There are 35 Federal departments, agen4 cies, and offices involved in the implementation of 

5 Federal diabetes activities. 

6 SEC. 3. ESTABLISHMENT OF THE NATIONAL DIABETES 

7 CLINICAL CARE COMMISSION. 

8 Part P of title III of the Public Health Service Act 

9 (42 U.S.C. 280g et seq.) is amended by adding at the end 

10 the following new section: 

11 ‘‘SEC. 399V–6. NATIONAL DIABETES CLINICAL CARE COM12 MISSION. 

13 ‘‘(a) ESTABLISHMENT.—There is hereby established 

14 within the Department of Health and Human Services a 

15 National Diabetes Clinical Care Commission (in this sec16 tion referred to as the ‘Commission’) to evaluate and rec17 ommend solutions regarding better coordination and the 

18 leveraging of programs within the Department of Health 

19 and Human Services and other Federal agencies that re20 late in any way to supporting appropriate clinical care 

21 (such as any interactions between physicians and other 

22 health care providers and their patients) related to the 

23 treatment and care management for people with pre-diabe24 tes, diabetes, and the chronic diseases and conditions that 

25 are complications of or caused by diabetes. 


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1 ‘‘(b) MEMBERSHIP.— 

2 ‘‘(1) IN GENERAL.—The Commission shall be 

3 composed of the following voting members: 

4 ‘‘(A) The heads (or their designees) of the 

5 following Federal agencies and departments 

6 that conduct programs that could impact the 

7 clinical care of people with pre-diabetes, diabe8 tes, and the chronic diseases and conditions 

9 that are complications of or caused by diabetes: 

10 ‘‘(i) The Centers for Medicare and 

11 Medicaid Services. 

12 ‘‘(ii) The Agency for Healthcare Re13 search and Quality. 

14 ‘‘(iii) The Centers for Disease Control 

15 and Prevention. 

16 ‘‘(iv) The Indian Health Service. 

17 ‘‘(v) The Department of Veterans Af18 fairs. 

19 ‘‘(vi) The National Institutes of 

20 Health. 

21 ‘‘(vii) The Food and Drug Adminis22 tration. 

23 ‘‘(viii) The Health Resources and 

24 Services Administration. 

25 ‘‘(ix) The Department of Defense. 


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1 ‘‘(x) Other governmental or non2 governmental agency heads, at the discre3 tion of the agency, that impact clinical 

4 care of individuals with pre-diabetes and 

5 diabetes. 

6 ‘‘(B) Twelve additional voting members ap7 pointed under paragraph (2). 

8 ‘‘(2) ADDITIONAL MEMBERS.—The Commission 

9 shall include additional voting members appointed by 

10 the Comptroller General of the United States, in 

11 consultation with national medical societies and pa12 tient advocate organizations with expertise in diabe13 tes and the care of patients with diabetes and the 

14 diseases it causes, including one or more from each 

15 of the following categories: 

16 ‘‘(A) Clinical endocrinologists. 

17 ‘‘(B) Physician specialties (other than as 

18 described in subparagraph (A)) that play a role 

19 in diabetes care, such as cardiologists, 

20 nephrologists, and eye care professionals. 

21 ‘‘(C) Primary care physicians. 

22 ‘‘(D) Non-physician health care profes23 sionals, such as certified diabetes educators, 

24 registered dieticians and nutrition professionals, 


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1 nurses, nurse practitioners, and physician as2 sistants. 

3 ‘‘(E) Patient advocates. 

4 ‘‘(F) National experts in the duties listed 

5 under subsection (c). 

6 ‘‘(3) CHAIRPERSON.—The voting members of 

7 the Commission shall select a chairperson from the 

8 members described in paragraph (2)(A). 

9 ‘‘(4) MEETINGS.—The Commission shall meet 

10 at least twice, and not more than 4 times, a year. 

11 ‘‘(5) BOARD TERMS.—Members of the Commis12 sion, including the chairperson, shall serve for a 3- 

13 year term. A vacancy on the Commission shall be 

14 filled in the same manner as the original appoint15 ments. 

16 ‘‘(c) DUTIES.—The Commission shall— 

17 ‘‘(1) evaluate programs of the Department of 

18 Health and Human Services regarding the utiliza19 tion of diabetes screening benefits, annual wellness 

20 visits, and other preventive health benefits that may 

21 reduce the risk of diabetes and the chronic diseases 

22 and conditions that are complications of diabetes, 

23 addressing any existing problems regarding such uti24 lization and related data collection mechanisms; 


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1 ‘‘(2) identify current activities and critical gaps 

2 in Federal efforts to support clinicians in providing 

3 integrated, high-quality care to people with pre-dia4 betes, diabetes, and the chronic diseases and condi5 tions that are complications of diabetes; 

6 ‘‘(3) make recommendations regarding the co7 ordination of clinically based activities that are being 

8 supported by the Federal Government; 

9 ‘‘(4) make recommendations regarding the de10 velopment and coordination of federally funded clin11 ical practice support tools for physicians and other 

12 health care professionals in caring for and managing 

13 the care of people with pre-diabetes, diabetes, and 

14 the chronic diseases and conditions that are com15 plications of diabetes, specifically with regard to the 

16 implementation of new treatments and technologies; 

17 ‘‘(5) evaluate programs in existence as of the 

18 date of the enactment of this section and determine 

19 if such programs are meeting the needs identified in 

20 paragraph (2) and, if such programs are determined 

21 to not be meeting such needs, recommend programs 

22 that would be more appropriate; 

23 ‘‘(6) recommend clinical pathways for new tech24 nologies and treatments, including future data col25 lection activities, and how they may be developed 


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1 and then used to evaluate and develop various care 

2 models and methods and the impact of such models 

3 and methods on quality of care and diabetes man4 agement as measured by appropriate care param5 eters (such as A1C, blood pressure, and cholesterol 

6 levels); 

7 ‘‘(7) evaluate and expand education and aware8 ness to physicians and other health care profes9 sionals regarding clinical practices for the prevention 

10 of diabetes and the chronic diseases and conditions 

11 that are complications of diabetes; 

12 ‘‘(8) review and recommend appropriate meth13 ods for outreach and dissemination of educational 

14 resources that regard diabetes prevention and treat15 ments, are funded by the Federal Government, and 

16 are intended for health care professionals and the 

17 public; and 

18 ‘‘(9) include other activities, such as those re19 lating to the areas of public health and nutrition, 

20 that the Commission deems appropriate. 

21 ‘‘(d) OPERATING PLAN.— 

22 ‘‘(1) INITIAL PLAN.—Not later than 90 days 

23 after its first meeting, the Commission shall submit 

24 to the Secretary and the Congress an operating plan 

25 for carrying out the activities of the Commission as 


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1 described in subsection (c). Such operating plan may 

2 include— 

3 ‘‘(A) a list of specific activities that the 

4 Commission plans to conduct for purposes of 

5 carrying out the duties described in each of the 

6 paragraphs in subsection (c); 

7 ‘‘(B) a plan for completing the activities; 

8 ‘‘(C) a list of members of the Commission 

9 and other individuals who are not members of 

10 the Commission who will need to be involved to 

11 conduct such activities; 

12 ‘‘(D) an explanation of Federal agency in13 volvement and coordination needed to conduct 

14 such activities; 

15 ‘‘(E) a budget for conducting such activi16 ties; 

17 ‘‘(F) a plan for evaluating the value and 

18 potential impact of the Commission’s work and 

19 recommendations, including the possible con20 tinuation of the Commission for the purposes of 

21 overseeing their implementation; and 

22 ‘‘(G) other information that the Commis23 sion deems appropriate. 

24 ‘‘(2) UPDATES.—The Commission shall periodi25 cally update the operating plan under paragraph (1) 


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1 and submit such updates to the Secretary and the 

2 Congress. 

3 ‘‘(e) FINAL REPORT AND SUNSET OF THE COMMIS4 SION.—By not later than 3 years after the date of the 

5 Commission’s first meeting, the Commission shall submit 

6 a report containing all of the findings and recommended 

7 actions of the Commission to the Secretary and Congress. 

8 Not later than 120 days after the submission of the final 

9 report, the Secretary shall review the evaluation required 

10 under subsection (d)(1)(F) to determine the continuation 

11 of the Commission. 

12 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—Appro13 priations are authorized to be made available to the Com14 mission for each of fiscal years 2016, 2017, and 2018, 

15 from amounts otherwise made available to the Department 

16 of Health and Human Services for such fiscal years, to 

17 carry out this section.’’. 

Æ 


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