I 
108TH CONGRESS 
1ST SESSION H. R. 3203
To amend the Public Health Service Act to authorize grants for education, 
screening, and treatment with the goal of preventing diabetic foot com-
plications and lower extremity amputations, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 30, 2003
Mr. BAKER (for himself, Mr. MCCRERY, Mr. JOHN, Mr. NETHERCUTT, Mr. 
JEFFERSON, Mrs. MCCARTHY of New York, and Mr. FALEOMAVAEGA) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To amend the Public Health Service Act to authorize grants 
for education, screening, and treatment with the goal 
of preventing diabetic foot complications and lower ex-
tremity amputations, and for other purposes.
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 ‘‘Diabetic Foot Com-
plication and Lower Extremity Amputation Reduction Act 
of 2003’’.
SEC. 2. FINDINGS. 
The Congress finds the following: 
(1) It is estimated that there are 17,000,000 
patients with diabetes in the United States and that 
diabetes costs the United States $132,000,000,000 
each year. 
(2) There has been a 61 percent increase in the 
number of Americans with diabetes since 1990. 
(3) Fifteen percent of people with diabetes will 
experience a foot ulcer, and between 14 and 24 per-
cent of those with a foot ulcer will require an ampu-
tation. 
(4) The increased incidence of diabetes has re-
sulted in more lower extremity amputations. From 
1980 to 1996, the number of diabetes-related hos-
pital discharges with lower extremity amputations 
increased from 36,000 to 86,000 per year. 
(5) The Medicare costs for diabetes patients 
with foot ulcers is 3 times higher than for diabetes 
patients in general, and inpatient care accounts for 
74 percent of diabetic ulcer-related costs. Therefore, 
cost effective ulcer prevention and treatment inter-
ventions will reduce Medicare costs. 
(6) Lower extremity amputations are dev-
astating to the patient, and with an average cost of
$60,000, these procedures are a costly burden on 
the health system. 
(7) Research shows that a multidisciplinary ap-
proach, including preventive strategies, patient and 
staff education, and treatment of foot ulcers, has 
been reported to reduce amputation rates by more 
than 50 percent at a fraction of the cost. 
SEC. 3. GRANTS FOR EDUCATION, SCREENING, AND TREAT-
MENT REGARDING DIABETIC FOOT COM-
PLICATIONS. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by inserting after section 330K 
the following: 
‘‘SEC. 330L. GRANTS FOR EDUCATION, SCREENING, AND 
TREATMENT 
REGARDING 
DIABETIC 
FOOT 
COMPLICATIONS. 
‘‘(a) GRANTS.—Subject to subsection (b), the Sec-
retary shall award grants to eligible entities for the fol-
lowing: 
‘‘(1) Providing a high-risk, underserved popu-
lation with screening, education, and evidence-based 
medical treatment regarding diabetic foot complica-
tions that may lead to lower extremity amputations. 
‘‘(2) Evaluating the quality, cost effectiveness, 
parity, and patient satisfaction of medical interven-
tions in the prevention of diabetic foot complications 
and lower extremity amputations. 
‘‘(b) RESTRICTION.—A grant under this section may 
be used to pay for a treatment only if the treatment is 
preventive in nature or is part of comprehensive outpatient 
care. 
‘‘(c) ELIGIBLE ENTITIES.—For purposes of this sec-
tion, the term ‘eligible entity’ means a multidisciplinary 
health care program, which may be university-based, that 
demonstrates to the Secretary’s satisfaction the following: 
‘‘(1) An ability to provide high-quality, cost-ef-
fective, and accessible treatment to a patient popu-
lation that has a high incidence of diabetes relative 
to the national average and a general inability to ac-
cess diabetic foot treatment programs. 
‘‘(2) An ability to successfully educate patients 
and health care providers about preventive health 
care measures and treatment methods for diabetic 
foot complications. 
‘‘(3) An ability to analyze and compile the re-
sults of research on diabetic foot complications and 
conduct additional research on diabetic foot com-
plications. 
‘‘(d) CRITERIA.—The Secretary, in consultation with 
appropriate professional organizations, shall develop cri-
teria for carrying out the grant program under this section 
and for collecting data to evaluate the effectiveness of the 
grant program. These criteria shall ensure the following: 
‘‘(1) The establishment of an authoritative, col-
laborative, multi-center study on the impact of com-
prehensive prevention and treatment of diabetic foot 
complications in high-risk, underserved populations, 
upon which future determinations can be based. 
‘‘(2) The establishment, in coordination with 
grant recipients, of evidence-based guidelines and 
standardized measurement outcomes that may be 
used to evaluate the overall results of projects under 
this section. 
‘‘(3) The provision to grant recipients of the 
necessary resources to develop programs that effec-
tively treat patients. 
‘‘(e) APPLICATION.—To seek a grant under this sec-
tion, an eligible entity must submit an application to the 
Secretary in such form, in such manner, and containing 
such information as the Secretary may require. 
‘‘(f) EVALUATIONS.—The Secretary may not award 
a grant to an eligible entity under this section unless the 
entity agrees to submit to the Secretary a yearly evalua-
tion of the entity’s operations and activities carried out 
under the grant.
‘‘(g) STUDY; REPORT.—Annually, the Secretary—
‘‘(1) shall conduct an authoritative study on the 
results of grants under this section, for the purpose 
of better informing future determinations regarding 
education, screening, and treatment of diabetic foot 
complications; and 
‘‘(2) shall submit a report on the findings and 
conclusions of the study to the Congress. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated $25,000,000 for fiscal year 2004 and 
such sums as may be necessary for each of fiscal years 
2005 through 2008.’’.
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