I
104TH CONGRESS
1ST SESSION
H. R. 1073
To amend title XVIII of the Social Security Act to provide for coverage
of diabetes outpatient self-management training services under part B
of the medicare program.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 28, 1995
Ms. FURSE (for herself, Mr. GEJDENSON, Mr. NETHERCUTT, and Mr. LIPIN-
SKI) 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 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 provide
for coverage of diabetes outpatient self-management
training 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. MEDICARE COVERAGE OF DIABETES OUT-
PATIENT 
SELF-MANAGEMENT 
TRAINING
SERVICES.
(a) IN GENERAL.—Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)), as amended by sec-
tion 147(f)(6)(B) of the Social Security Act Amendments
of 1994, is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (N);
(2) by striking ‘‘and’’ at the end of subpara-
graph (O); and
(3) by inserting after subparagraph (O) the fol-
lowing new subparagraph:
‘‘(P) diabetes outpatient self-management train-
ing 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, 1996.
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