I 
111TH CONGRESS 
1ST SESSION H. R. 2590 
To amend title XVIII of the Social Security Act to reduce the occurrence 
of diabetes in Medicare beneficiaries by extending coverage under Medi-
care for medical nutrition therapy services to such beneficiaries with 
pre-diabetes or with risk factors for developing type 2 diabetes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 21, 2009 
Ms. DEGETTE (for herself, Mr. CASTLE, Mr. BECERRA, and Mr. KIRK) intro-
duced 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 reduce 
the occurrence of diabetes in Medicare beneficiaries by 
extending coverage under Medicare for medical nutrition 
therapy services to such beneficiaries with pre-diabetes 
or with risk factors for developing type 2 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 ‘‘Preventing Diabetes 
in Medicare Act of 2009’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) According to the American Diabetes Asso-
ciation, there are 57,000,000 people with pre-diabe-
tes in America. 
(2) For a significant number of people with 
pre-diabetes, intervening early can reverse elevated 
blood glucose levels to normal range and prevent di-
abetes and its complications completely. 
(3) Diabetes-related hospitalizations totaled 
24.3 million days in 2007, an increase of 7.4 million 
from the 16.9 million days in 2002. 
(4) Preventing diabetes and its complications 
can save money and lives. The average annual cost 
to treat someone with diabetes is $11,744. 
(5) Diabetes is unique because its complications 
and their associated health care cost are preventable 
with currently available medical treatment and life-
style changes. 
(6) In 2002, the Diabetes Prevention Program 
study conducted by the National Institutes of Health 
found that participants (all of whom were at in-
creased risk of developing type 2 diabetes) who made 
lifestyle changes reduced their risk of developing 
type 2 diabetes by 58 percent and that participants 
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aged 60 and older reduced their risk of developing 
diabetes by 71 percent. 
(7) The Agency for Healthcare Research and 
Quality 
(AHRQ) 
has 
demonstrated 
that 
$2,500,000,000 in hospitalization costs related to 
the treatment of diabetes or complications resulting 
from diabetes could be saved by providing seniors 
with appropriate primary care to prevent the onset 
of diabetes. 
(8) The Medicare program currently screens 
and identifies beneficiaries with pre-diabetes but 
does not provide adequate services to such bene-
ficiaries to prevent them from becoming diabetic. 
SEC. 3. MEDICARE COVERAGE OF MEDICAL NUTRITION 
THERAPY SERVICES FOR PEOPLE WITH PRE- 
DIABETES AND RISK FACTORS FOR DEVEL-
OPING TYPE 2 DIABETES. 
(a) IN GENERAL.—Subsection (s)(2)(V) of section 
1861 of the Social Security Act (42 U.S.C. 1395x) is 
amended— 
(1) by inserting ‘‘, pre-diabetes (as defined in 
subsection (hhh)),’’ after ‘‘with diabetes’’; and 
(2) by inserting ‘‘, or an individual at risk for 
diabetes (as defined in subsection (yy)(2)),’’ after 
‘‘or a renal disease’’. 
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(b) DEFINITION OF PRE-DIABETES.—Such section is 
further amended by adding at the end the following new 
subsection: 
‘‘Pre-Diabetes 
‘‘(hhh) The term ‘pre-diabetes’ means a condition of 
impaired fasting glucose or impaired glucose tolerance 
identified by a blood glucose level that is higher than nor-
mal, but not so high as to indicate actual diabetes.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to services furnished 
on or after January 1, 2010. 
Æ 
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