I 
109TH CONGRESS 
2D SESSION 
H. R. 6231 
To catalyze change in the care and treatment of diabetes in America. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 28, 2006 
Mr. FITZPATRICK of Pennsylvania (for himself and Mr. CHANDLER) intro-
duced the following bill; which was referred to the Committee on Energy 
and Commerce 
A BILL 
To catalyze change in the care and treatment of diabetes 
in America. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS; AND FIND-
INGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Catalyst to Better Diabetes Care Act of 2006’’. 
(b) TABLE OF CONTENTS.—The table of contents is 
as follows: 
Sec. 1. Short title; table of contents; and findings. 
Sec. 2. Advisory group regarding diabetes and chronic illness employee wellness 
incentivization and disease management best practices. 
Sec. 3. National diabetes report card. 
Sec. 4. Medicare diabetes screening collaboration and outreach program. 
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Sec. 5. Improvement of diabetes mortality data collection. 
Sec. 6. Study on appropriate level of diabetes medical education. 
(c) FINDINGS.—The Congress finds as follows: 
(1) Diabetes is a chronic public health problem 
in the United States that is getting worse. 
(2) According to the Centers for Disease Con-
trol and Prevention: 
(A) One in three Americans born in 2006 
will get diabetes. 
(B) One in two American minorities born 
in 2006 will get diabetes. 
(C) 1.5 million new cases of diabetes were 
diagnosed in adults in 2005. 
(D) In 2005, 20.8 million Americans had 
diabetes, which is 7 percent of the population of 
the United States. 
(E) 6.2 million Americans are currently 
undiagnosed. 
(F) About one in every 500 children and 
adolescents have type 1 diabetes. 
(G) African-Americans are nearly twice as 
likely as whites to have diabetes. 
(H) Nearly 13 percent of American Indi-
ans and Alaska Natives over 20 years old have 
diagnosed diabetes. 
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(I) In States with significant Asian popu-
lations, Asians were 1.5 to 2 times as likely as 
whites to have diagnosed diabetes. 
(3) Diabetes carries staggering costs: 
(A) In 2002, the total direct and indirect 
costs of diabetes was estimated at $132 billion 
according to the American Diabetes Associa-
tion. 
(B) 18 percent of the Medicare population 
has diabetes but spending on this group of peo-
ple consumes 32 percent of the Medicare budg-
et according to the Center for Medicare and 
Medicaid Services. 
(4) Diabetes is deadly. According to the Centers 
for Disease Control and Prevention: 
(A) In 2002, according to death certificate 
reports, diabetes contributed to an official num-
ber of 224,092 deaths. 
(B) Diabetes is likely to be seriously 
underreported as studies have found that only 
35 precent to 40 percent of decedent with dia-
betes had it listed anywhere on the death cer-
tificate and only about 10 percent to 15 percent 
had it listed as the underlying cause of death. 
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(5) Diabetes complications carry staggering eco-
nomic and human costs for our country and health 
system: 
(A) According to death certificate reports, 
diabetes contributes to over 224,000 death a 
year, although this number is likely vastly 
underreported. 
(B) The risk for stroke is 2 to 4 times 
higher among people with diabetes. 
(C) Diabetes is the leading cause of new 
blindness in America, causing approximately 
18,000 new cases of blindness each year. 
(D) Diabetes is the leading cause of kidney 
failure in America, accounting for 44 percent of 
new cases in 2002. 
(E) In 2002, 44,400 Americans with dia-
betes began treatment for end-stage kidney dis-
ease and a total of 153,730 were living on 
chronic dialysis or with a kidney transplant as 
a result of their diabetes. 
(F) In 2002, approximately 82,000 ampu-
tations were performed on Americans with dia-
betes. 
(G) Poorly controlled diabetes before con-
ception and during the first trimester of preg-
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nancy can cause major birth defects in 5 per-
cent to 10 percent of pregnancies and sponta-
neous abortions in 15 percent to 20 percent of 
pregnancies. 
(6) Diabetes is unique because its complications 
and tremendous costs are preventable with currently 
available medical treatment: 
(A) 
According 
to 
the 
Agency 
for 
Healthcare Research and Quality, appropriate 
primary care for diabetes complications could 
have saved the Medicare and Medicaid pro-
grams $2,500,000,000 in hospital costs in 2001 
alone. 
(B) According to the Diabetes Prevention 
Program sponsored by the National Institutes 
of Health, lifestyle interventions such as diet 
and moderate physical activity for those with 
pre-diabetes reduced the development of diabe-
tes by 58 percent; among Americans aged 60 
and over, lifestyle interventions reduced diabe-
tes by 71 percent. 
(C) Research shows detecting and treating 
diabetic eye disease can reduce the development 
of severe vision loss by 50 percent to 60 per-
cent. 
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(D) Research shows comprehensive foot 
care programs can reduce amputation rates by 
45 percent to 85 percent. 
(E) Research shows detecting and treating 
early diabetic kidney disease by lowering blood 
pressure can reduce the decline in kidney func-
tion by 30 percent to 70 percent. 
SEC. 2. ADVISORY GROUP REGARDING DIABETES AND 
CHRONIC 
ILLNESS 
EMPLOYEE 
WELLNESS 
INCENTIVIZATION AND DISEASE MANAGE-
MENT BEST PRACTICES. 
(a) ESTABLISHMENT.—The Secretary of Commerce 
shall establish an advisory group consisting of representa-
tives of the public and private sector. The advisory group 
shall include representatives from the Department of 
Commerce, the Department of Health and Human Serv-
ices, the Small Business Administration, and public and 
private sector entities with experience in administering or 
operating employee wellness and disease management pro-
grams. 
(b) DUTIES.—The advisory group established under 
subsection (a) shall examine and make recommendations 
of best practices of chronic illness employee wellness 
incentivization and disease management programs in 
order to— 
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(1) provide public and private sector entities 
with improved information in assessing the role of 
employee wellness incentivization and disease man-
agement programs in saving money and improving 
quality of life for patients with chronic illnesses; and 
(2) encourage the adoption of effective chronic 
illness employee wellness and disease management 
programs. 
(c) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the advisory group shall sub-
mit to the Secretary of Health and Human Services, the 
Speaker and minority leader of the House of Representa-
tives, and the majority leader and minority leader of the 
Senate, the results of the examination under subsection 
(b)(1). 
SEC. 3. NATIONAL DIABETES REPORT CARD. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section and sections 
4 through 6 as the ‘‘Secretary’’), in collaboration with the 
Director of the Centers for Disease Control and Preven-
tion (referred to in this section as the ‘‘Director’’), shall 
prepare a national diabetes report card (referred to in this 
section as a ‘‘Report Card’’) for the Nation and, to the 
extent possible, for each State on a biennial basis, that 
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includes the statistically valid aggregate health outcomes 
related to individuals diagnosed with diabetes including— 
(1) HbA1c level; 
(2) LDL; 
(3) blood pressure; and 
(4) complications and comorbidities. 
(b) REPORT.—The Secretary, in collaboration with 
the Director, shall— 
(1) submit each Report Card to Congress; and 
(2) make each Report Card readily available in 
print and electronically to each State and to the 
public. 
(c) ADAPTABLE.—Each Report Card shall be able to 
be adapted by State and, where possible, local agencies 
in order to rate or report local diabetes care, costs, and 
prevalence. 
(d) UPDATED REPORT.—Each Report Card that is 
prepared after the initial Report Card shall include trend 
analysis for the Nation, and, to the extent possible, for 
each State, in order to track progress in meeting estab-
lished national goals and objectives for improving diabetes 
care, costs, and prevalence (including Healthy People 
2010), and to inform policy and program development. 
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SEC. 4. MEDICARE DIABETES SCREENING COLLABORATION 
AND OUTREACH PROGRAM. 
(a) ESTABLISHMENT.—With respect to diabetes 
screening tests provided for under the Medicare Prescrip-
tion Drug, Improvement, and Modernization Act of 2003 
and for the purposes of reducing the number of 
undiagnosed beneficiaries with diabetes or prediabetes in 
the Medicare program, the Secretary, in collaboration with 
the Director of the Centers for Disease Control and Pre-
vention, shall establish an outreach program— 
(1) to identify existing efforts to increase 
awareness among Medicare beneficiaries and pro-
viders of the diabetes screening benefit; 
(2) to maximize economies of scale, cost-effec-
tiveness, and resource allocation in increasing utili-
zation of the Medicare diabetes screening program; 
and 
(3) build upon ongoing efforts of the private 
and non-profit sector; 
(b) CONSULTATION.—In carrying out this section, 
the Secretary and the Director shall consult with— 
(1) various units of the Federal Government, 
including the Centers for Medicare & Medicaid Serv-
ices, the Surgeon General of the Public Health Serv-
ice, the Agency for Health Research and Quality, the 
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Health Resources and Services Administration, and 
the National Institutes of Health; and 
(2) entities with an interest in diabetes, includ-
ing industry, voluntary health organization, trade as-
sociations, and professional societies. 
SEC. 5. IMPROVEMENT OF DIABETES MORTALITY DATA 
COLLECTION. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Centers for Disease Control and Preven-
tion, and in collaboration with appropriate agencies, shall 
conduct, support, and promote the collection, analysis, and 
publication of biennial data on the prevalence and inci-
dence of type 1 and 2 diabetes and of pre-diabetes. 
(b) IMPROVEMENT OF MORTALITY DATA COLLEC-
TION.— 
(1) ASSESSMENT.—The activities described in 
subsection (a) shall include an assessment of diabe-
tes as a primary or underlying cause of death and 
analysis of any under-reporting of diabetes as a pri-
mary or underlying cause of death in order to pro-
vide an accurate estimate of yearly deaths related to 
diabetes. 
(2) DEATH
CERTIFICATE
ADDITIONAL
LAN-
GUAGE.—In carrying out the activities described in 
subsection (b)(1), the Secretary may promote the 
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addition of language to death certificates to improve 
collection of diabetes mortality data, including add-
ing questions for the individual certifying to the 
cause of death regarding whether the deceased had 
diabetes and whether diabetes was an immediate, 
underlying, or contributing cause of or condition 
leading to death. 
(c) REPORT.— 
(1) IN GENERAL.—The Secretary and the Di-
rector shall submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate and 
the Committee on Energy and Commerce of the 
House of Representatives annual reports describing 
the activities undertaken under this section. 
(2) CONTENT.—The reports shall include an— 
(A) analysis of any under-reporting of dia-
betes as a primary or underlying cause of death 
in order to provide an accurate estimate of 
yearly deaths related to diabetes; and 
(B) projections regarding trends in each of 
the areas described in subparagraph (A). 
(3) AVAILABILITY.—The Secretary and the Di-
rector shall make such reports publicly available in 
print and on the Internet site of the Centers for Dis-
ease Control and Prevention. 
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