I 
115TH CONGRESS 
2D SESSION 
H. R. 5768 
To amend title XVIII of the Social Security Act to improve access to diabetes 
outpatient self-management training services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 10, 2018 
Mr. REED (for himself and Ms. DEGETTE) 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 provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
access to diabetes outpatient self-management training 
services, 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 ‘‘Expanding Access to 
Diabetes Self-Management Training Act of 2018’’ or the 
‘‘Expanding Access to DSMT Act of 2018’’. 
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SEC. 2. IMPROVING ACCESS TO DIABETES OUTPATIENT 
SELF-MANAGEMENT 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 (1)— 
(A) by striking ‘‘the Secretary determines 
appropriate’’ and inserting ‘‘specified in para-
graph (3)’’; 
(B) by inserting ‘‘or qualified nonphysician 
practitioner’’ after ‘‘only if the physician’’; and 
(C) by inserting ‘‘(or other physician or 
qualified nonphysician practitioner furnishing 
items or services to such individual, in coordina-
tion with the physician or qualified nonphysi-
cian practitioner managing such individual’s di-
abetic condition)’’ after ‘‘managing the individ-
ual’s diabetic condition’’; 
(2) in paragraph (2)(B), by striking ‘‘para-
graph’’ and inserting ‘‘subparagraph’’; and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(3) For purposes of paragraph (1), the times speci-
fied in this paragraph are the following: 
‘‘(A) An initial 10 hours of educational and 
training services described in paragraph (1), to re-
main available until used. 
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‘‘(B) Six additional hours (or a greater number 
of hours if determined appropriate by the Secretary) 
of such services during the year in which the indi-
vidual exhausts the initial hours described in sub-
paragraph (A), provided that the physician or quali-
fied nonphysician practitioner who is managing the 
individual’s diabetic condition (or other physician or 
qualified nonphysician practitioner furnishing items 
or services to such individual, in coordination with 
the physician or qualified nonphysician practitioner 
managing such individual’s diabetic condition) cer-
tifies the medical necessity of such additional hours. 
‘‘(C) Six additional hours (or a greater number 
of hours if determined appropriate by the Secretary) 
of such services per year for each year beginning 
after the year in which the individual exhausts the 
initial hours described in subparagraph (A), provided 
that the physician or qualified nonphysician practi-
tioner who is managing the individual’s diabetic con-
dition (or other physician or qualified nonphysician 
practitioner furnishing items or services to such in-
dividual, in coordination with the physician or quali-
fied nonphysician practitioner managing such indi-
vidual’s diabetic condition) certifies the medical ne-
cessity of such additional hours. 
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‘‘(iii) the individual meets other criteria 
that necessitates such additional number of 
hours, as determined by the Secretary. 
‘‘(4) For purposes of this section, the term ‘qualified 
nonphysician practitioner’ means a physician assistant, 
nurse practitioner, or clinical nurse specialist (as defined 
in section 1861(aa)(5)).’’. 
(b) MEDICAL NUTRITION THERAPY SERVICES.—Sec-
tion 
1861(s)(2)(V) 
of 
such 
Act 
(42 
U.S.C. 
1395x(s)(2)(V)) is amended— 
(1) by striking clause (i); 
(2) by redesignating clauses (ii) and (iii) as 
clauses (i) and (ii), respectively; and 
(3) in clause (ii), as so redesignated, by striking 
‘‘after consideration of’’ and inserting ‘‘consistent 
with’’. 
(c) COST-SHARING.—Section 1833 of such Act (42 
U.S.C. 1395l) is amended— 
(1) in subsection (a)(1)— 
(A) by striking ‘‘and (BB)’’ and inserting 
‘‘(BB)’’; and 
(B) by striking the semicolon at the end 
and inserting ‘‘, and (CC) with respect to diabe-
tes outpatient self-management training serv-
ices (as defined in section 1861(qq)), the 
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amount paid shall be 100 percent of the lesser 
of the actual charge for the services or the 
amount determined under the fee schedule that 
applies to such services under this part;’’; and 
(2) in subsection (b)— 
(A) by striking ‘‘and (10)’’ and inserting 
‘‘(10)’’; and 
(B) by striking ‘‘1861(hhh)(1)).’’ and in-
serting ‘‘1861(hhh)(1)), and (11) such deduct-
ible shall not apply with respect to diabetes out-
patient self-management training services (as 
defined in section 1861(qq)).’’ 
(d) REVISION OF MANUAL.—Not later than 180 days 
after the date of the enactment of this Act, the Secretary 
of Health and Human Services shall revise the Medicare 
Benefit Policy Manual to ensure that diabetes outpatient 
self-management training services (as defined in section 
1861(qq) of the Social Security Act (42 U.S.C. 
1395x(qq)), as amended by subsection (a)) may be fur-
nished by an entity that is a hospital outpatient depart-
ment at alternate, nonhospital sites (including community- 
based locations). 
(e) APPLICATION.—The amendments made by this 
section shall apply with respect to items and services fur-
nished on or after January 1, 2019. 
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SEC. 3. VIRTUAL DIABETES OUTPATIENT SELF-MANAGE-
MENT TRAINING SERVICES DEMONSTRATION 
PROGRAM. 
(a) IN GENERAL.—Beginning not later than January 
1, 2019, the Secretary of Health and Human Services (in 
this section referred to as the ‘‘Secretary’’) shall select an 
appropriate number of applicable beneficiaries to partici-
pate in a 2-year demonstration program to test the impact 
of furnishing diabetes outpatient self-management train-
ing services through a qualified online platform with re-
spect to cost and clinical outcomes for such applicable 
beneficiaries. Under such program, diabetes outpatient 
self-management training services furnished through a 
qualified online platform to an applicable beneficiary shall 
be covered under title XVIII of the Social Security Act, 
and payment for such services shall be made in the same 
manner as payment is made under such title for such serv-
ices furnished in an outpatient setting. 
(b) DEFINITIONS.—In this section: 
(1) APPLICABLE BENEFICIARY.—The term ‘‘ap-
plicable beneficiary’’ means an individual— 
(A) who is enrolled under part B of title 
XVIII of the Social Security Act; 
(B) who has a diagnosis of diabetes; and 
(C) who agrees to take part in the dem-
onstration program described in subsection (a). 
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(2) QUALIFIED ONLINE PLATFORM.—The term 
‘‘qualified online platform’’ means an online-based 
platform— 
(A) designed to furnish educational and 
training services to an individual with diabetes 
to ensure therapy compliance with respect to 
the individual’s diabetic condition or to provide 
the individual with necessary skills and knowl-
edge (including skills related to the self-admin-
istration of injectable drugs) to participate in 
the individual’s management of such condition; 
and 
(B) that meets the National Standards for 
Diabetes Self-Management Education and Sup-
port, as jointly published by the American Asso-
ciation of Diabetes Educators and the American 
Diabetes Association. 
(3) DIABETES
SELF-MANAGEMENT
TRAINING 
SERVICES.—The term ‘‘diabetes outpatient self-man-
agement training services’’ has the meaning given 
such term in section 1861(qq) of the Social Security 
Act (42 U.S.C. 1395x(qq)) except that the require-
ment in paragraph (1) of such section with respect 
to such services being furnished in an outpatient set-
ting shall not apply. 
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(c) EVALUATION.—The Secretary shall evaluate the 
demonstration program described in subsection (a) based 
on the following criteria: 
(1) The improvement, if any, in health out-
comes with respect to the diabetic conditions of ap-
plicable beneficiaries participating in such program 
as evidenced by— 
(A) any improvement attributable to such 
program in the knowledge of such beneficiaries 
with respect to such conditions; 
(B) any behavioral changes attributable to 
such program; 
(C) any clinical outcome improvements at-
tributable to such program; 
(D) any quality of life improvements at-
tributable to such program; and 
(E) the overall satisfaction of such bene-
ficiaries with such program. 
(2) Reductions, if any, in expenditures under 
title XVIII of the Social Security Act attributable to 
such program. 
(3) Other criteria determined appropriate by 
the Secretary. 
(d) REPORT.—Not later than 18 months after the 
date of the completion of the demonstration program de-
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scribed in subsection (a), the Secretary shall submit to 
Congress a report containing— 
(1) the results of the evaluation described in 
subsection (c); 
(2) an analysis of the demographic characteris-
tics of applicable beneficiaries who participated in 
such program; and 
(3) a recommendation on whether such program 
should be continued or expanded. 
(e) WAIVER AUTHORITY.—The Secretary may waive 
such requirements of titles XI and XVIII of the Social 
Security Act (42 U.S.C. 1301 et seq., 1395 et seq.) as 
may be necessary to carry out the provisions of this sec-
tion. 
(f) AUTHORITY TO EXPAND DEMONSTRATION PRO-
GRAM.—Notwithstanding subsection (a), taking into ac-
count the evaluation described in subsection (c), the Sec-
retary may, through rulemaking, expand the duration and 
the scope of the demonstration program described in sub-
section (a), to the extent determined appropriate by the 
Secretary, if— 
(1) the Secretary determines that such expan-
sion is expected to— 
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(A) reduce spending under title XVIII of 
the Social Security Act without reducing quality 
of care; or 
(B) improve the quality of care for individ-
uals enrolled under part B of such title without 
increasing spending under such title; 
(2) the Chief Actuary of the Centers for Medi-
care & Medicaid Services certifies that such expan-
sion would reduce (or would not result in any in-
crease in) net program spending under such title; 
and 
(3) the Secretary determines that such expan-
sion would not deny or limit the coverage or provi-
sion of benefits under such title for individuals en-
rolled under part B of such title. 
Æ 
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