I 
113TH CONGRESS 
1ST SESSION H. R. 1274 
To amend title XVIII of the Social Security Act to improve access to diabetes 
self-management training by authorizing certified diabetes educators to 
provide diabetes self-management training services, including as part 
of telehealth services, under part B of the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 19, 2013 
Mr. WHITFIELD (for himself and Ms. DEGETTE) 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 subse-
quently 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 self-management training by author-
izing certified diabetes educators to provide diabetes self- 
management training services, including as part of tele-
health 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 ‘‘Access to Quality Dia-
betes Education Act of 2013’’. 
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SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) The Centers for Disease Control and Pre-
vention (hereinafter ‘‘CDC’’) report that nearly 
26,000,000 Americans have diabetes, in addition to 
an estimated 79,000,000 Americans who have 
prediabetes, an increase of 24,000,000 Americans 
with either diabetes or prediabetes since 2008. Peo-
ple with prediabetes are at increased risk of devel-
oping Type 2 diabetes or cardiovascular disease. 
(2) Diabetes impacts 8.3 percent of all Ameri-
cans and 11.3 percent of American adults. The CDC 
estimates that as many as 1 in 3 Americans will 
have diabetes by 2050 if current trends continue. 
(3) According to the American Diabetes Asso-
ciation, the total costs of diagnosed diabetes have 
risen to $245 billion in 2012 from $174 billion in 
2007, when the cost was last examined by the CDC. 
This figure represents a 41 percent increase over a 
five-year period. 
(4) One in 3 Medicare dollars is currently spent 
on people with diabetes. 
(5) There were 11.3 million diabetes related 
emergency room visits in 2008, compared with 9.5 
million in 2000, an increase of 11 percent. 
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(6) According to the CDC, health care pro-
viders are finding statistically significant increases 
in the prevalence of Type 2 diabetes in children and 
adolescents. 
(7) Diabetes self-management training (herein-
after ‘‘DSMT’’), also called diabetes education, pro-
vides critical knowledge and skills training to pa-
tients with diabetes, helping them manage medica-
tions, address nutritional issues, facilitate diabetes- 
related problem solving, and make other critical life-
style changes to effectively manage their diabetes. 
Evidence shows that individuals participating in 
DSMT programs are able to progress along the con-
tinuum necessary to make sustained behavioral 
changes in order to manage their diabetes. 
(8) A certified diabetes educator is a State li-
censed or registered health care professional who 
specializes in helping people with diabetes develop 
the self-management skills needed to stay healthy 
and avoid costly acute complications and emergency 
care, as well as debilitating secondary conditions 
caused by diabetes. 
(9) Diabetes self-management training has been 
proven effective in helping to reduce the risks and 
complications of diabetes and is a vital component of 
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an overall diabetes treatment regimen. Patients who 
have received training from a certified diabetes edu-
cator are better able to implement the treatment 
plan received from a physician skilled in diabetes 
treatment. 
(10) Lifestyle changes, such as those taught by 
certified diabetes educators, directly contribute to 
better glycemic control and reduced complications 
from diabetes. Evidence shows that the potential for 
prevention of the most serious medical complications 
caused by diabetes to be as high as 90 percent 
(blindness), 85 percent (amputations), and 50 per-
cent (heart disease and stroke) with proper medical 
treatment and active self-management. 
(11) In recognition of the important role of 
DSMT programs, the CDC in 2012 awarded fund-
ing to expand the National Diabetes Prevention Pro-
gram to help prevent the onset of Type 2 diabetes 
for individuals at high risk. 
(12) The net savings to the Medicare program 
of ensuring that beneficiaries have access to quality 
DSMT is estimated to be $2,000,000,000 over 10 
years. 
(13) Despite its effectiveness in reducing diabe-
tes-related complications and associated costs, diabe-
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tes self-management training has been recognized by 
the Centers for Medicare & Medicaid Services as an 
underutilized Medicare benefit, even after more than 
a decade of coverage. 
(14) Enhancing access to diabetes self-manage-
ment training programs that are certified as nec-
essary by the patient’s treating physician and taught 
by certified diabetes educators is an important pub-
lic policy goal that can help improve health out-
comes, ensure quality, and reduce escalating diabe-
tes-related health costs. 
SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU-
CATORS AS AUTHORIZED PROVIDERS OF 
MEDICARE 
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), by striking ‘‘by a certified 
provider (as described in paragraph (2)(A)) in an 
outpatient setting’’ and inserting ‘‘in an outpatient 
setting by a certified diabetes educator (as defined 
in paragraph (3)) or by a certified provider (as de-
scribed in paragraph (2)(A))’’; and 
(2) by adding at the end the following new 
paragraphs: 
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‘‘(3) For purposes of paragraph (1), the term ‘cer-
tified diabetes educator’ means an individual— 
‘‘(A) who is licensed or registered by the State 
in which the services are performed as a certified di-
abetes educator; or 
‘‘(B) who— 
‘‘(i) is licensed or registered by the State 
in which the services are performed as a health 
care professional; 
‘‘(ii) specializes in teaching individuals 
with diabetes to develop the necessary skills and 
knowledge to manage the individual’s diabetic 
condition; and 
‘‘(iii) is certified as a diabetes educator by 
a recognized certifying body (as defined in 
paragraph (4)). 
‘‘(4) For purposes of paragraph (3)(B)(iii), the term 
‘recognized certifying body’ means a certifying body for 
diabetes educators which is recognized by the Secretary 
as authorized to grant certification of diabetes educators 
for purposes of this subsection pursuant to standards es-
tablished by the Secretary.’’. 
(b) TREATMENT AS A PRACTITIONER, INCLUDING 
FOR TELEHEALTH SERVICES.—Section 1842(b)(18)(C) of 
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the such Act (42 U.S.C. 1395u(b)(18)(C)) is amended by 
adding at the end the following new clause: 
‘‘(vii) A certified diabetes educator (as defined 
in section 1861(qq)(3)).’’. 
(c) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study to identify the 
barriers that exist for Medicare beneficiaries with di-
abetes in accessing diabetes self-management train-
ing services under the Medicare program, including 
economic and geographic barriers and availability of 
appropriate referrals and access to adequate and 
qualified providers. 
(2) REPORT.—Not later than 1 year after the 
date of the enactment of this Act, the Comptroller 
General of the United States shall submit to Con-
gress a report on the study conducted under para-
graph (1). 
(d) AHRQ DEVELOPMENT OF RECOMMENDATIONS 
FOR OUTREACH METHODS AND REPORT.— 
(1) DEVELOPMENT OF RECOMMENDATIONS.— 
The Director of the Agency for Healthcare Research 
and Quality shall, through use of a workshop and 
other appropriate means, develop a series of rec-
ommendations on effective outreach methods to edu-
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cate physicians and other health care providers as 
well as the public about the benefits of diabetes self- 
management training in order to promote better 
health outcomes for patients with diabetes. 
(2) REPORT.—Not later than 1 year after the 
date of the enactment of this Act, the Director of 
the Agency for Healthcare Research and Quality 
shall submit to Congress a report on the rec-
ommendations developed under paragraph (1). 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished 
after the end of the 12-month period beginning on the date 
of the enactment of this Act. 
Æ 
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