SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Diabetes 
Self-Management Training Act of 2009’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Diabetes is widely recognized as one of the 
top public health threats currently facing the United 
States. Approximately 24,000,000 people in the 
United States are currently living with diabetes, and 
another 57,000,000 people in the United States have 
pre-diabetes, dramatically raising their risk of devel-
oping diabetes, heart disease, and stroke. Three mil-
lion individuals with diagnosed diabetes receive no 
treatment for the disease, and only about 56 percent 
of those newly diagnosed with diabetes receive the 
type of diet and exercise counseling that are vital 
components of a diabetes self management training 
(DSMT) regimen. The number of Americans living 
with diabetes increased 50 percent between 1997– 
2004, and the Centers for Disease Control projects 
that the prevalence of diagnosed diabetes in the U.S. 
will increase 165 percent by 2050. 
(2) Diabetes costs the United States over $174 
billion annually, with $116 billion attributed to di-
rect medical costs associated with diabetes care, and 
$58 billion attributed to indirect costs associated 
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with lost productivity. Eighteen percent of all Medi-
care beneficiaries have diabetes, accounting for 32 
percent of Medicare spending. 
(3) Diabetes self-management training, also 
called diabetes education, provides critical knowledge 
and skills training to patients with diabetes, helping 
them identify barriers, facilitate problem solving, 
and develop coping skills to effectively manage their 
diabetes. 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. 
(4) Diabetes self-management training has been 
proven effective in helping to reduce the risks and 
complications of diabetes. In 2002, the Diabetes 
Prevention Program study conducted by the Na-
tional Institutes of Health and the Centers for Dis-
ease Control and Prevention 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. 
Lifestyle intervention worked in all of the groups but 
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it worked particularly well in people aged 60 and 
older, reducing the development of diabetes by 71 
percent. Similarly, studies have found that patients 
under the care of a certified diabetes educator are 
better able to control their diabetes and report im-
provement in their health status. 
(5) 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. 
(6) There are currently more than 20,000 dia-
betes educators in the United States, most of whom 
are certified diabetes educators credentialed by the 
National Certification Board for Diabetes Edu-
cators. Eligibility for certification as a diabetes edu-
cator by the National Certification Board for Diabe-
tes Educators requires prerequisite qualifying pro-
fessional credentials in specific health care profes-
sions and professional practice experience that in-
cludes a minimum number of hours and years of ex-
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perience in diabetes self-management training. Dia-
betes educators certified by the National Certifi-
cation Board for Diabetes Educators must also pass 
a rigorous national examination and periodically 
renew their credentials. Diabetes educators certified 
by the National Certification Board for Diabetes 
Educators, and licensed by a State as a health pro-
fessional, are uniquely qualified to provide diabetes 
self-management training under the Medicare pro-
gram. 
(7) Enhancing access to diabetes self-manage-
ment training programs that are taught by Certified 
Diabetes Educators is an important public policy 
goal that can help improve health outcomes, ensure 
quality, and reduce escalating diabetes-related health 
costs. 
SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDU-
CATORS AS CERTIFIED PROVIDERS FOR PUR-
POSES 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 inserting ‘‘or by a cer-
tified diabetes educator (as defined in paragraph 
(3))’’ after ‘‘paragraph (2)(B)’’; and 
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(2) by adding at the end the following new 
paragraphs: 
‘‘(3) For purposes of paragraph (1), the term 
‘certified diabetes educator’ means an individual 
who— 
‘‘(A) is licensed or registered by the State 
in which the services are performed as a health 
care professional; 
‘‘(B) specializes in teaching individuals 
with diabetes to develop the necessary skills and 
knowledge to manage the individual’s diabetic 
condition; and 
‘‘(C) is certified as a diabetes educator by 
a recognized certifying body (as defined in 
paragraph (4)). 
‘‘(4)(A) For purposes of paragraph (3)(B), the 
term ‘recognized certifying body’ means— 
‘‘(i) the National Certification Board 
for Diabetes Educators, or 
‘‘(ii) a certifying body for diabetes 
educators, which is recognized by the Sec-
retary as authorized to grant certification 
of diabetes educators for purposes of this 
subsection pursuant to standards estab-
lished by the Secretary, 
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