I 
108TH CONGRESS 
1ST SESSION H. R. 3194
To amend title XVIII of the Social Security Act to improve access to diabetes 
self-management training by designating certified diabetes educators rec-
ognized by the National Certification Board of Diabetes Educators as 
certified providers for purposes of outpatient diabetes education services 
under part B of the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 25, 2003
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 recognized by the Na-
tional Certification Board of Diabetes Educators as cer-
tified providers for purposes of outpatient diabetes edu-
cation 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 2003’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Diabetes is the fifth leading cause of death 
in the United States. Over 17,000,000 Americans 
(6.2 percent of the population) currently are living 
with diabetes, a number that is estimated to increase 
to 29,000,000 by the year 2050. In 2002, diabetes 
accounted for $132,000,000,000 in direct and indi-
rect health care costs. Diabetes is widely recognized 
as one of the top public health threats facing our na-
tion today. 
(2) Diabetes can occur in 2 forms—type 1 dia-
betes is caused by the body’s inability to produce in-
sulin, a hormone that allows glucose or sugar to 
enter and fuel cells, and type 2 diabetes, which oc-
curs when the body fails to make enough insulin, or 
fails to properly use it. People with type 1 diabetes 
are required to take daily insulin injections to stay 
alive. While some people with type 2 diabetes need 
insulin shots, others with type 2 diabetes can control 
their diabetes through healthy diet, nutrition, and 
lifestyle changes. Type 2 diabetes accounts for up to 
95 percent of all diabetes cases affecting 8 percent
of the population age 20 and older. The prevalence 
of type 2 diabetes has tripled in the last 30 years, 
with much of that increase due to an upsurge in 
obesity. 
(3) The Diabetes Prevention Program study in 
2002 found that participants (all of whom were at 
increased risk of developing type 2 diabetes) who 
made lifestyle changes reduced their risk of getting 
type 2 diabetes by 58 percent. 
(4) Diabetes self-management training (DSMT) 
also called diabetes education, provides knowledge 
and skill training to patients with diabetes, helping 
them identify barriers, facilitate problem solving, 
and develop coping skills to effectively manage their 
diabetes. Unlike many other diseases, diabetes re-
quires constant vigilance on the part of the patient 
and demands far more than just taking pills or insu-
lin shots. A certified diabetes educator is a health 
care professional—often a nurse, dietitian, or phar-
macist, who specializes in helping people with diabe-
tes 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) There are currently over 13,000 diabetes 
educators in the United States, most of whom are 
certified diabetes educators (CDEs). To earn a CDE 
designation, a health care professional must be li-
censed or have received a masters degree in a rel-
evant public health concentration, have completed 2 
years of professional practice experience in diabetes 
self-management training, and have provided a min-
imum of 1000 hours of diabetes self-management 
training. Many other health care professionals that 
are able to bill for diabetes education through the 
medicare program have far less experience or ability 
to provide the skilled expertise to help people with 
diabetes self-manage the disease. CDEs are the best 
trained health care professionals to provide DSMT 
and their experience and background is in stark con-
trast to the 12 hours of continuing education that 
non-physician health care providers or suppliers 
must obtain every 2 years, as required by the Cen-
ters for Medicare & Medicaid Services. 
(6) CDEs represent the only group of health 
care professionals who provide diabetes self-manage-
ment training that have not been recognized as 
health care providers and are therefore precluded 
from directly billing the medicare program for
DSMT. Adding CDEs as providers to that program 
would give diabetes patients access to the care they 
need. 
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 
‘‘and includes a certified diabetes educator (as 
defined in paragraph (3)) who is recognized by 
the National Certification Board of Diabetes 
Educators and is working within a recognized 
diabetes education program’’ before the semi-
colon at the end; and 
(B) in subparagraph (B), by inserting be-
fore the period at the end the following: ‘‘or is 
a certified diabetes educator (as so defined) 
who is recognized by the National Certification 
Board of Diabetes Educators and is working 
within a recognized diabetes education pro-
gram’’; and 
(2) by adding at the end the following:
‘‘(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) is a licensed nurse, occupational therapist, 
optometrist, pharmacist, physical therapist, physi-
cian assistant, podiatrist, a registered dietitian, or 
has an advanced degree in nutrition, social work, 
clinical psychology, exercise physiology, health edu-
cation or a related public health area such as health 
education, health promotion, health and social be-
havior or health communication; 
‘‘(C) has at least 2 years of professional prac-
tice experience in diabetes self-management training; 
‘‘(D) has provided a minimum of 1000 hours of 
diabetes self-management training to patients within 
the most recent 5 years; and 
‘‘(E) has passed a certification exam approved 
by the National Certification Board of Diabetes 
Educators.’’. 
(b) GAO STUDY AND REPORT.—
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study to determine the
barriers, if any, that exist in rural areas to success-
fully becoming a recognized diabetes education pro-
gram, including the difficulty of rural health care 
professionals in becoming certified diabetes edu-
cators (as defined in section 1861(qq)(3) of the So-
cial Security Act (as added by subsection (a)(2))), 
and whether individuals with diabetes who live in 
rural areas have barriers to accessing diabetes self-
management training. 
(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 (2). 
(c) EFFECTIVE DATE.—The amendments made by 
subsection (a) apply to diabetes outpatient self-manage-
ment training services furnished on or after October 1, 
2003.
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