I 
116TH CONGRESS 
1ST SESSION H. R. 1840 
To amend title XVIII of the Social Security Act to improve access to diabetes 
outpatient self-management training services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 21, 2019 
Mr. REED (for himself, Ms. DEGETTE, Mr. RUIZ, Ms. DELBENE, Mrs. 
BROOKS of Indiana, and Mr. KELLY of Pennsylvania) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
access to diabetes outpatient self-management training 
services, 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 ‘‘Expanding Access to 
Diabetes Self-Management Training Act of 2019’’ or the 
‘‘Expanding Access to DSMT Act of 2019’’. 
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SEC. 2. IMPROVING ACCESS TO 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)— 
(A) by striking ‘‘the Secretary determines 
appropriate’’ and inserting ‘‘specified in para-
graph (3)’’; 
(B) by inserting ‘‘or qualified nonphysician 
practitioner’’ after ‘‘only if the physician’’; and 
(C) by inserting ‘‘(or other physician or 
qualified nonphysician practitioner furnishing 
items or services to such individual, in coordina-
tion with the physician or qualified nonphysi-
cian practitioner managing such individual’s di-
abetic condition)’’ after ‘‘managing the individ-
ual’s diabetic condition’’; 
(2) in paragraph (2)(B), by striking ‘‘para-
graph’’ and inserting ‘‘subparagraph’’; and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(3) For purposes of paragraph (1), the times speci-
fied in this paragraph are the following: 
‘‘(A) An initial 10 hours of educational and 
training services described in paragraph (1), to re-
main available until used. 
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‘‘(B) Six additional hours (or a greater number 
of hours if determined appropriate by the Secretary) 
of such services during the year in which the indi-
vidual exhausts the initial hours described in sub-
paragraph (A), provided that the physician or quali-
fied nonphysician practitioner who is managing the 
individual’s diabetic condition (or other physician or 
qualified nonphysician practitioner furnishing items 
or services to such individual, in coordination with 
the physician or qualified nonphysician practitioner 
managing such individual’s diabetic condition) cer-
tifies the medical necessity of such additional hours. 
‘‘(C) Six additional hours (or a greater number 
of hours if determined appropriate by the Secretary) 
of such services per year for each year beginning 
after the year in which the individual exhausts the 
initial hours described in subparagraph (A), provided 
that the physician or qualified nonphysician practi-
tioner who is managing the individual’s diabetic con-
dition (or other physician or qualified nonphysician 
practitioner furnishing items or services to such in-
dividual, in coordination with the physician or quali-
fied nonphysician practitioner managing such indi-
vidual’s diabetic condition) certifies the medical ne-
cessity of such additional hours. 
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‘‘(D) For a year in which the individual has re-
ceived additional hours described in subparagraph 
(B) or (C) and exhausted such hours, an additional 
number of hours determined appropriate by the phy-
sician or qualified nonphysician practitioner who is 
managing the individual’s diabetic condition (or 
other physician or qualified nonphysician practi-
tioner furnishing items or services to such indi-
vidual, in coordination with the physician or quali-
fied nonphysician practitioner managing such indi-
vidual’s diabetic condition), provided that the physi-
cian or qualified nonphysician practitioner who is 
managing the individual’s diabetic condition (or 
other physician or qualified nonphysician practi-
tioner furnishing items or services to such indi-
vidual, in coordination with the physician or quali-
fied nonphysician practitioner managing such indi-
vidual’s diabetic condition) certifies that— 
‘‘(i) there has been a change in the individ-
ual’s diagnosis, medical condition, or treatment 
regimen; 
‘‘(ii) the individual is not meeting appro-
priate clinical outcomes (as determined by such 
physician or qualified nonphysician practitioner) 
for such condition; or 
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‘‘(iii) the individual meets other criteria 
that necessitates such additional number of 
hours, as determined by the Secretary. 
‘‘(4) For purposes of this section, the term ‘qualified 
nonphysician practitioner’ means a physician assistant, 
nurse practitioner, or clinical nurse specialist (as defined 
in section 1861(aa)(5)).’’. 
(b) MEDICAL NUTRITION THERAPY SERVICES.—Sec-
tion 
1861(s)(2)(V) 
of 
such 
Act 
(42 
U.S.C. 
1395x(s)(2)(V)) is amended— 
(1) by striking clause (i); 
(2) by redesignating clauses (ii) and (iii) as 
clauses (i) and (ii), respectively; and 
(3) in clause (ii), as so redesignated, by striking 
‘‘after consideration of’’ and inserting ‘‘consistent 
with’’. 
(c) COST-SHARING.—Section 1833 of such Act (42 
U.S.C. 1395l) is amended— 
(1) in subsection (a)(1)— 
(A) by striking ‘‘and (CC)’’ and inserting 
‘‘(CC)’’; and 
(B) by striking the semicolon at the end 
and inserting ‘‘, and (DD) with respect to dia-
betes outpatient self-management training serv-
ices (as defined in section 1861(qq)), the 
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amount paid shall be 100 percent of the lesser 
of the actual charge for the services or the 
amount determined under the fee schedule that 
applies to such services under this part;’’; and 
(2) in subsection (b)— 
(A) by striking ‘‘and (10)’’ and inserting 
‘‘(10)’’; and 
(B) by striking ‘‘1861(hhh)(1)).’’ and in-
serting ‘‘1861(hhh)(1)), and (11) such deduct-
ible shall not apply with respect to diabetes out-
patient self-management training services (as 
defined in section 1861(qq)).’’ 
(d) REVISION OF MANUAL.—Not later than 180 days 
after the date of the enactment of this Act, the Secretary 
of Health and Human Services shall revise the Medicare 
Benefit Policy Manual to ensure that diabetes outpatient 
self-management training services (as defined in section 
1861(qq) of the Social Security Act (42 U.S.C. 
1395x(qq)), as amended by subsection (a)) may be fur-
nished by an entity that is a hospital outpatient depart-
ment at alternate, nonhospital sites (including community- 
based locations). 
(e) APPLICATION.—The amendments made by this 
section shall apply with respect to items and services fur-
nished on or after January 1, 2020. 
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