I 
117TH CONGRESS 
1ST SESSION H. R. 5804 
To amend title XVIII of the Social Security Act to improve access to diabetes 
outpatient self-management training services, to require the Center for 
Medicare and Medicaid Innovation to test the provision of virtual diabetes 
outpatient self-management training services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 1, 2021 
Ms. SCHRIER (for herself, Mr. REED, Ms. DEGETTE, Mr. UPTON, Ms. 
DELBENE, 
Mr. 
KELLY
of 
Pennsylvania, 
Mr. 
RUIZ, 
and 
Mr. 
SCHWEIKERT) 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 committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
access to diabetes outpatient self-management training 
services, to require the Center for Medicare and Medicaid 
Innovation to test the provision of virtual diabetes out-
patient 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, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Expanding Access to 
Diabetes Self-Management Training Act of 2021’’. 
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 
paragraph: 
‘‘(3) For purposes of paragraph (1), the times speci-
fied in this paragraph are the following: 
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‘‘(A) An initial 10 hours of educational and 
training services to remain available until used. 
‘‘(B) No more than 2 hours of individual or 
group educational and training services each year, 
including the year in which the initial 10 hours de-
scribed in subparagraph (A) are completed.’’. 
(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 the Social Se-
curity Act (42 U.S.C. 1395l) is amended— 
(1) in subsection (a)(1)— 
(A) by striking ‘‘and (DD)’’ and inserting 
‘‘(DD)’’; and 
(B) by striking the semicolon at the end 
and inserting ‘‘and (EE) with respect to diabe-
tes outpatient self-management training serv-
ices (as defined in section 1861(qq)), the 
amount paid shall be 100 percent of the lesser 
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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), in the first sentence— 
(A) by striking ‘‘and (12)’’ and inserting 
‘‘(12)’’; and 
(B) by striking the period at the end and 
inserting ‘‘, and (13) such deductible shall not 
apply with respect to diabetes outpatient self- 
management training services (as defined in 
section 1861(qq)).’’ 
(d) APPLICATION.—The amendments made by this 
section shall apply with respect to items and services fur-
nished on or after January 1, 2023. 
SEC. 3. CMI TESTING OF PROVIDING VIRTUAL DIABETES 
OUTPATIENT SELF-MANAGEMENT TRAINING 
SERVICES. 
Section 1115A of the Social Security Act (42 U.S.C. 
1315a) is amended— 
(1) in subsection (b)(2)(A), by adding at the 
end the following new sentence: ‘‘The models se-
lected under this subparagraph shall include the 
testing of the model described in subsection (h).’’; 
and 
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(2) by adding at the end the following new sub-
section: 
‘‘(h) TESTING OF PROVIDING VIRTUAL DIABETES 
OUTPATIENT
SELF-MANAGEMENT
TRAINING
SERV-
ICES.— 
‘‘(1) ESTABLISHMENT.—Not later than Janu-
ary 1, 2023, the Secretary shall implement a model 
to test the impact of providing coverage under title 
XVIII for virtual diabetes outpatient self-manage-
ment training services furnished to applicable bene-
ficiaries with respect to improved health outcomes 
for such applicable beneficiaries and reduced expend-
itures under such title XVIII. 
‘‘(2) MODEL DESIGN.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
design the model under this subsection in such 
a manner to allow for the evaluation of demo-
graphic characteristics of applicable bene-
ficiaries participating in such model and the ex-
tent to which such model accomplishes the fol-
lowing purposes: 
‘‘(i) Improvement in health outcomes 
with respect to the diabetic conditions, in-
cluding by reducing A1c levels. 
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‘‘(ii) Reduced hospitalizations due to 
diabetic-related complications. 
‘‘(iii) Increased utilization of diabetes 
outpatient self-management training serv-
ices as evidenced by, for example, Medicare 
beneficiary participation and utilization of 
covered hours during the first year and 
subsequent years or use of diabetes out-
patient self-management training services 
in rural and underserved communities. 
‘‘(iv) Improved medication adherence. 
‘‘(v) Reduced expenditures under this 
title attributable to the model. 
‘‘(B) CONSULTATION.—In designing the 
model under this subsection, the Secretary 
shall, not later than 3 months after the date of 
the enactment of this subsection, consult with 
stakeholders in the field of diabetes care and 
education, clinicians in the primary care com-
munity, experts in digital health, and bene-
ficiary groups. 
‘‘(3) DEFINITIONS.—In this subsection: 
‘‘(A) 
APPLICABLE
BENEFICIARY.—The 
term ‘applicable beneficiary’ means an indi-
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vidual with diabetes as described in section 
1861(qq). 
‘‘(B) QUALIFIED WEB-BASED PROGRAM.— 
The term ‘qualified web-based program’ means 
a web-based program— 
‘‘(i) designed to furnish educational 
and training services to an individual with 
diabetes to ensure therapy compliance with 
respect to the individual’s diabetic condi-
tion or to provide the individual with nec-
essary skills and knowledge (including 
skills related to the self-administration of 
injectable drugs) to participate in the indi-
vidual’s management of such condition; 
and 
‘‘(ii) that meets the quality standards 
described in section 1861(qq)(2)(B). 
‘‘(C) VIRTUAL
DIABETES
OUTPATIENT 
SELF-MANAGEMENT TRAINING SERVICES.—The 
term ‘virtual diabetes outpatient self-manage-
ment training services’ means any diabetes out-
patient self-management training services (as 
defined in section 1861(qq)) furnished by a 
qualified web-based program for synchronous or 
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