I 
109TH CONGRESS 
1ST SESSION H. R. 3612 
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 out-
patient diabetes self-management training services under part B of the 
Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 28, 2005 
Mr. WELDON of Pennsylvania (for himself and Ms. DEGETTE) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration 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 improve 
access to diabetes self management training by desig-
nating 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 pro-
viders for purposes of outpatient diabetes self-manage-
ment training services under part B of the Medicare 
Program.
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 ‘‘Diabetes Self Manage-
ment Training Act of 2005’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Diabetes is widely recognized as one of the 
top public health threats facing our Nation today. 
More than 18,000,000 Americans are currently liv-
ing with diabetes and that number is expected to 
double by the year 2050. Diabetes is the sixth lead-
ing cause of death in the United States, causing 
more than 200,000 deaths each year. 
(2) Diabetes occurs in two forms. Type 1 diabe-
tes is caused by the body’s inability to produce insu-
lin, a hormone that allows glucose to enter and fuel 
cells. Type 2 diabetes occurs when the body fails to 
make enough insulin or fails to properly use it. Type 
1 diabetes typically develops in childhood or adoles-
cence and accounts for only 5 to 10 percent of cases 
of diabetes. Type 2 diabetes accounts for 90 to 95 
percent of diabetes cases and most often appears 
among people older than 40. It is especially common
in the medicare population, as 1 in 5 adults over age 
65 has type 2 diabetes. 
(3) Diabetes is a costly disease. In 2002, diabe-
tes accounted for $132,000,000,000 in direct and in-
direct health care costs. It is especially costly for the 
medicare program. Individuals with diabetes rep-
resent approximately 20 percent of medicare bene-
ficiaries but account for more than 30 percent of 
fee-for-service medicare expenditures. 
(4) People with type 1 diabetes are required to 
take daily insulin injections to stay alive. While some 
people with type 2 diabetes need daily insulin injec-
tions, others with type 2 diabetes can control their 
diabetes through healthy meal plans, exercise, and, 
for some, oral medications. Diabetes self manage-
ment training (in this section referred to as 
‘‘DSMT’’), also called diabetes education, provides 
knowledge and skills training to patients with diabe-
tes, helping them identify barriers, facilitate problem 
solving, and develop coping skills to effectively man-
age their diabetes. A certified diabetes educator is a 
health care professional, often a nurse, dietitian, or 
pharmacist, who specializes in helping people with 
diabetes develop the self-management skills needed 
to stay healthy and avoid costly acute complications
and emergency care, as well as debilitating sec-
ondary conditions caused by diabetes. 
(5) DSMT has been proven effective in helping 
to reduce the risks and complications of diabetes. In 
2002, the Diabetes Prevention Program study found 
that participants (all of whom were at increased risk 
of developing type 2 diabetes) who made lifestyle 
changes, such as those taught in DSMT programs, 
reduced their risk of getting type 2 diabetes by 58 
percent. Lifestyle intervention worked in all of the 
groups but it worked particularly well in people aged 
60 and older, reducing the development of diabetes 
by 71 percent. Similarly, studies have found that pa-
tients under the care of a certified diabetes educator 
are better able to control their diabetes and report 
improvement in their health status. Congress recog-
nized the value of DSMT by creating medicare cov-
erage for this benefit under the Balanced Budget 
Act of 1997. 
(6) There are currently more than 20,000 dia-
betes educators in the United States, most of whom 
are certified diabetes educators credentialed by the 
National Certification Board for Diabetes Educators 
(NCBDE). Eligibility for certification as a diabetes 
educator requires prerequisite qualifying professional
credentials in specified health care professions and 
professional practice experience that includes a min-
imum number of hours of experience in DSMT. Cer-
tified diabetes educators must also pass a rigorous 
national examination and periodically renew their 
credentials. Certified diabetes educators are uniquely 
qualified to provide DSMT under the medicare pro-
gram. 
SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU-
CATORS AS MEDICARE PROVIDERS FOR PUR-
POSES OF DIABETES OUTPATIENT SELF-MAN-
AGEMENT TRAINING SERVICES. 
(a) IN GENERAL.—Section 1861(qq) of the Social Se-
curity Act (42 U.S.C. 1395x(qq)) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A), by inserting ‘‘, or 
a certified diabetes educator (as defined in 
paragraph (3)) who is credentialed by a nation-
ally recognized certifying body for diabetes edu-
cators’’ before the semicolon at the end; and 
(B) in subparagraph (B), by striking ‘‘a 
physician’’ through ‘‘meets applicable’’ and in-
serting the following: ‘‘a physician, or such 
other individual or entity, or a certified diabetes 
educator meets the quality standards described
in this paragraph if the physician, other indi-
vidual or entity, or certified diabetes educator 
meets quality standards established by the Sec-
retary, except that the physician, other indi-
vidual or entity, or certified diabetes educator 
shall be deemed to have met such standards if 
the physician, other individual or entity, or cer-
tified diabetes educator meets applicable’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(3) For purposes of paragraph (2), the term ‘cer-
tified diabetes educator’ means an individual who— 
‘‘(A) is a health care professional who special-
izes in helping individuals with diabetes develop the 
self-management skills needed to overcome the daily 
challenges and problems caused by the disease; 
‘‘(B) has met all criteria for initial certification, 
including a prerequisite qualifying professional cre-
dential in a specified health care profession, has pro-
fessional practice experience in diabetes self-manage-
ment training that includes a minimum number of 
hours of diabetes self-management training, and has 
passed a national examination offered by a certifying 
body recognized as entitled to grant certification to 
diabetes educators; and
‘‘(C) has periodically renewed certification sta-
tus following initial certification.’’. 
(b) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study to identify the 
barriers that exist for individuals with diabetes in 
accessing diabetes self management training, includ-
ing economic and geographic barriers and avail-
ability of appropriate referrals and access to ade-
quate, qualified providers. 
(2) REPORT.—Not later than 1 year after the 
date of enactment of this Act, the Comptroller Gen-
eral of the United States shall submit a report to 
Congress regarding the study conducted under para-
graph (1). 
(c) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to diabetes outpatient self-man-
agement training services furnished on or after the date 
that is 6 months after the date of enactment of this Act. 
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