I 
114TH CONGRESS 
1ST SESSION H. R. 2102 
To amend title XVIII of the Social Security Act to reduce the incidence 
of diabetes among Medicare beneficiaries, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 29, 2015 
Mrs. DAVIS of California (for herself, Mr. KING of New York, Mr. RIBBLE, 
Mr. TAKAI, Mr. SMITH of New Jersey, and Mr. FITZPATRICK) introduced 
the following bill; which was referred to the Committee on Energy and 
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 com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to reduce 
the incidence of diabetes among Medicare beneficiaries, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Diabetes 
Prevention Act of 2015’’. 
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SEC. 2. DIABETES PREVENTION UNDER THE MEDICARE 
PROGRAM. 
(a) COVERAGE OF DIABETES PREVENTION PROGRAM 
SERVICES.— 
(1) COVERAGE OF SERVICES.— 
(A) IN GENERAL.—Section 1861(s)(2) of 
the Social Security Act (42 U.S.C. 1395x(s)(2)) 
is amended— 
(i) in subparagraph (EE), by striking 
‘‘and’’ after the semicolon at the end; 
(ii) in subparagraph (FF), by insert-
ing ‘‘and’’ after the semicolon at the end; 
and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(GG) items and services furnished under a di-
abetes prevention program (as defined in subsection 
(iii)(1)) to an eligible diabetes prevention program 
individual (as defined in subsection (iii)(2));’’. 
(B) DEFINITIONS.—Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is 
amended by adding at the end the following 
new subsection: 
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‘‘Diabetes Prevention Program; Eligible Diabetes Preven-
tion Program Individual; Qualified Diabetes Preven-
tion Program Provider 
‘‘(iii)(1)(A) The term ‘diabetes prevention program’ 
means a program that— 
‘‘(i) meets the criteria described in subpara-
graph (B); and 
‘‘(ii) is furnished by a qualified diabetes preven-
tion program provider (as defined in paragraph 
(3)(A)). 
‘‘(B) The Secretary shall establish the criteria for a 
diabetes prevention program. Such criteria shall be in ac-
cordance with the standards under the National Diabetes 
Prevention Program, as established by the Centers for 
Disease Control and Prevention, and shall require that the 
program complies with the Federal regulations (con-
cerning the privacy of individually identifiable health in-
formation) promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act of 
1996. In establishing such criteria, the Secretary may also 
consider other factors or clinical evidence as the Secretary 
determines appropriate. 
‘‘(C) Items and services furnished under a diabetes 
prevention program may, as determined appropriate by 
the Secretary, be furnished in-person in a community set-
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ting, virtually, or via one or more proven distance-learning 
modalities. 
‘‘(D) The Secretary shall establish procedures under 
which a qualified diabetes prevention program provider 
may contract with a diabetes prevention program delivery 
partner to furnish the items and services under a diabetes 
prevention program. Items and services may be furnished 
in one or some combination of the settings described in 
subparagraph (C). For purposes of this subsection, the 
term ‘diabetes prevention program delivery partner’ means 
an entity, including non-profit organizations, public and 
private hospitals, State and local departments of public 
health, and Federally qualified health centers, that meets 
criteria established by the Secretary. Such criteria shall 
be in accordance with the standards under the National 
Diabetes Prevention Program, as established by the Cen-
ters for Disease Control and Prevention. In establishing 
such criteria, the Secretary may also consider other fac-
tors or clinical evidence as the Secretary determines ap-
propriate. 
‘‘(2)(A) The term ‘eligible diabetes prevention pro-
gram individual’ means an individual at risk for diabetes 
(as defined in subsection (yy)(2)) who would benefit from 
items and services under a diabetes prevention program, 
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‘‘(i) furnish the items and services under the di-
abetes prevention program through a delivery part-
ner (pursuant to paragraph (1)(D)) unless no such 
delivery partner is available; 
‘‘(ii) manage, track, and verify the outcomes of 
a diabetes prevention program (including attendance 
and observed weight loss of participating individuals) 
through defined systems which cannot rely solely on 
data self-reported by participating individuals, in-
cluding outcomes of programs furnished under con-
tract with a diabetes prevention program delivery 
partner as defined in paragraph (1)(D); 
‘‘(iii) implement business processes to manage 
program workflow, such as eligibility, reporting, 
claims billing, class scheduling, and enrollment; 
‘‘(iv) manage and verify billing accuracy and 
beneficiary eligibility (as described in paragraph 
(2)); 
‘‘(v) comply with applicable laws and regula-
tions and ensure such compliance by a diabetes pre-
vention program delivery partner; 
‘‘(vi) perform various forms of engagement 
with, and outreach to, eligible diabetes prevention 
program individuals, including those participating in 
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programs furnished under contract with a diabetes 
prevention program delivery partner; 
‘‘(vii) comply with all program integrity require-
ments as established by the Secretary; and 
‘‘(viii) perform such other functions as estab-
lished by the Secretary.’’. 
(2) AMOUNT OF PAYMENT.—Section 1833(a)(1) 
of the Social Security Act (42 U.S.C. 1395l(a)(1)) 
is amended— 
(A) by striking ‘‘and (Z)’’ and inserting 
‘‘(Z)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (AA) with respect 
to items and services furnished under a diabetes 
prevention program (as defined in section 
1861(iii)(1)), the amount paid shall be 100 per-
cent of (i) except as provided in clause (ii), the 
lesser of the actual charge for the items and 
services or the amount determined under the 
fee schedule that applies to such items and 
services under this part, as determined by the 
Secretary, and (ii) in the case of such items and 
services that are covered OPD services (as de-
fined in subsection (t)(1)(B)), the amount de-
termined under subsection (t)’’. 
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(3) WAIVER
OF
APPLICATION
OF
DEDUCT-
IBLE.—The first sentence of section 1833(b) of the 
Social Security Act (42 U.S.C. 1395l(b)) is amend-
ed— 
(A) by striking ‘‘and’’ before ‘‘(10)’’; and 
(B) by inserting before the period the fol-
lowing: ‘‘, and (11) such deductible shall not 
apply with respect to items and services under 
a diabetes prevention program (as defined in 
section 1861(iii)(1))’’. 
(4) 
ASSIGNMENT
OF
CLAIMS.—Section 
1842(b)(18)(C) of the Social Security Act (42 
U.S.C. 1395u(b)(18)(C)) is amended by adding at 
the end the following new clause: 
‘‘(vii) A qualified diabetes prevention program 
provider (as defined in section 1861(iii)(3)(A)).’’. 
(5) EXCLUSION
OF
ITEMS
AND
SERVICES 
UNDER A DIABETES PREVENTION PROGRAM FROM 
SKILLED NURSING FACILITY PROSPECTIVE PAYMENT 
SYSTEM.—Section 1888(e)(2)(A)(ii) of the Social Se-
curity Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amend-
ed by inserting ‘‘items and services under a diabetes 
prevention 
program 
(as 
defined 
in 
section 
1861(iii)(1)),’’ after ‘‘qualified psychologist serv-
ices,’’. 
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(6) INCLUSION
IN
FEDERALLY
QUALIFIED 
HEALTH CENTER SERVICES.—Section 1861(aa)(3) of 
the Social Security Act (42 U.S.C. 1395x(aa)(3)) is 
amended— 
(A) in subparagraph (A), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (B), by striking the 
comma at the end and inserting ‘‘; and’’; and 
(C) by adding after subparagraph (B) the 
following new subparagraph: 
‘‘(C) items and services under a diabetes pre-
vention 
program 
(as 
defined 
in 
section 
1861(iii)(1)),’’. 
(7) SPECIAL CONSIDERATION FOR THE DUAL 
ELIGIBLE
POPULATION.—In 
implementing 
the 
amendments made by this subsection, the Secretary 
of Health and Human Services shall give special 
consideration to the needs of individuals who are du-
ally eligible for benefits under the Medicare and 
Medicaid programs. 
(8) EVALUATION AND REPORT TO CONGRESS.— 
(A) 
EVALUATION.—The 
Secretary 
of 
Health and Human Services shall conduct an 
evaluation on the coverage of items and services 
under a diabetes prevention program under the 
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Medicare program, as added by the amend-
ments made by this subsection. Such evaluation 
shall include an analysis of— 
(i) the impact of the provision of such 
coverage on Medicare beneficiaries, includ-
ing the impact on various populations, 
such as individuals who are dually eligible 
for benefits under the Medicare and Med-
icaid programs and individuals living in 
rural or medically underserved areas, and 
the impact of the provision of such cov-
erage on health disparities; 
(ii) the rate at which physicians refer 
eligible diabetes prevention program indi-
viduals to diabetes prevention programs 
under the Medicare program; 
(iii) Medicare beneficiary participation 
levels in diabetes prevention programs 
under the Medicare program and the 
awareness of Medicare beneficiaries of the 
benefit; 
(iv) the health outcomes resulting 
from completion of a diabetes prevention 
program under the Medicare program, in-
cluding any measurable variations in out-
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come between different program settings 
described in section 1861(iii)(1)(C) of the 
Social Security Act, as added by paragraph 
(1)(B); 
(v) program integrity protections im-
portant to diabetes prevention programs 
under the Medicare program; and 
(vi) other areas determined appro-
priate by the Secretary. 
(B) REPORT.—Not later than January 1, 
2021, the Secretary of Health and Human 
Services shall submit to Congress a report on 
the evaluation conducted under subparagraph 
(A), together with recommendations for such 
legislation and administrative actions as the 
Secretary determines appropriate. 
(9) EFFECTIVE DATE.—The amendments made 
by paragraphs (1) through (6) shall apply with re-
spect to services furnished on or after January 1, 
2017. 
(b) INCLUSION OF REFERRAL RATES TO DIABETES 
PREVENTION PROGRAMS IN THE MEDICARE PHYSICIAN 
QUALITY REPORTING SYSTEM.—Section 1848(k)(2)(C)(i) 
of the Social Security Act (42 U.S.C. 1395w– 
4(k)(2)(C)(i)) is amended by adding at the end the fol-
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