I
104TH CONGRESS
2D SESSION
H. R. 4264
To amend title XVIII of the Social Security Act to improve Medicare treat-
ment and education for beneficiaries with diabetes by providing coverage
of diabetes outpatient self-management training services and uniform
coverage of blood-testing strips for individuals with diabetes.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 27, 1996
Mr. NETHERCUTT (for himself, Mr. WELDON of Pennsylvania, Mr. GINGRICH,
Mr. WATTS of Oklahoma, Mr. BONILLA, and Mr. BILIRAKIS) introduced
the following bill; which was referred to the Committee on 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 consider-
ation 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
Medicare treatment and education for beneficiaries with
diabetes by providing coverage of diabetes outpatient self-
management training services and uniform coverage of
blood-testing strips for individuals with diabetes.
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 ‘‘Medicare Diabetes
Education and Treatment Amendments of 1996’’.
SEC. 2. MEDICARE COVERAGE OF DIABETES OUTPATIENT
SELF-MANAGEMENT TRAINING SERVICES.
(a) IN GENERAL.—Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graphs (M) and (O), and
(2) by inserting after subparagraph (O) the fol-
lowing new subparagraph:
‘‘(R) 
diabetes 
outpatient 
self-management
training services (as defined in subsection (oo));
and’’.
(b) DEFINITION.—Section 1861 of such Act (42
U.S.C. 1395x) is amended by adding at the end the follow-
ing new subsection:
‘‘Diabetes Outpatient Self-management Training Services
‘‘(oo)(1) The term ‘diabetes outpatient self-manage-
ment training services’ means educational and training
services furnished to an individual with diabetes by or
under arrangements with a certified provider (as described
in paragraph (2)(A)) in an outpatient setting by an indi-
vidual or entity who meets the quality standards described
in paragraph (2)(B), but only if the physician who is man-
aging the individual’s diabetic condition certifies that such
services are needed under a comprehensive plan of care
related to the individual’s diabetic condition to provide the
individual with necessary skills and knowledge (including
skills related to the self-administration of injectable drugs)
to participate in the management of the individual’s condi-
tion.
‘‘(2) In paragraph (1)—
‘‘(A) a ‘certified provider’ is an individual or
entity that, in addition to providing diabetes out-
patient self-management training services, provides
other items or services for which payment may be
made under this title; and
‘‘(B) an individual or entity meets the quality
standards described in this paragraph if the individ-
ual or entity meets quality standards established by
the Secretary, except that the individual or entity
shall be deemed to have met such standards if the
individual or entity meets applicable standards origi-
nally established by the National Diabetes Advisory
Board and subsequently revised by organizations
who participated in the establishment of standards
by such Board, or is recognized by the American Di-
abetes Association as meeting standards for furnish-
ing the services.’’.
(c) CONSULTATION WITH ORGANIZATIONS IN ESTAB-
LISHING PAYMENT AMOUNTS FOR SERVICES PROVIDED
BY PHYSICIANS.—In establishing payment amounts under
section 1848(a) of the Social Security Act for physicians’
services consisting of diabetes outpatient self-management
training services, the Secretary of Health and Human
Services shall consult with appropriate organizations, in-
cluding the American Diabetes Association, in determining
the relative value for such services under section
1848(c)(2) of such Act.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 1997.
SEC. 3. MEDICARE COVERAGE OF BLOOD-TESTING STRIPS
FOR INDIVIDUALS WITH DIABETES.
(a) INCLUDING
STRIPS
AS
DURABLE
MEDICAL
EQUIPMENT.—Section 1861(n) of the Social Security Act
(42 U.S.C. 1395x(n)) is amended by striking the semi-
colon in the first sentence and inserting the following: ‘‘,
and includes blood-testing strips for individuals with dia-
betes without regard to whether the individual has Type
I or Type II diabetes (as determined under standards es-
tablished by the Secretary in consultation with the Amer-
ican Diabetes Association);’’.