‘‘(3)(A)(i) The term ‘qualified diabetes prevention 
program provider’ means any entity, including a Federally 
qualified health center, that the Secretary determines— 
‘‘(I) is appropriate to furnish items and services 
under a diabetes prevention program; and 
‘‘(II) meets criteria established by the Sec-
retary, in consultation with the Centers for Disease 
Control and Prevention. 
‘‘(ii) A qualified diabetes prevention program pro-
vider may be, as determined appropriate by the Secretary, 
a supplier (as defined in subsection (d)), a provider of 
services (as defined in subsection (u)), a health insurance 
or services company, a community-based organization, or 
any other appropriate entity. 
‘‘(B) A qualified diabetes prevention program pro-
vider shall— 
‘‘(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 and track the outcomes of a diabe-
tes prevention program (including attendance and 
weight loss of participating individuals) through de-
fined systems, including outcomes of programs fur-
nished under contract with a diabetes prevention 
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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 
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 
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(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)’’. 
(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))’’. 
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(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,’’. 
(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: 
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‘‘(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 
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 the impact of the pro-
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vision of such coverage on health dispari-
ties; 
(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; 
(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, 
2019, 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 
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