Expanding Access to Diabetes Self-Management Training Act of 2021
Bill: H.R.5804 | Sponsor: Rep. Schrier, Kim (D-WA)
Policy area: Health

Summary:
Expanding Access to Diabetes Self-Management Training Act of 2021
This bill expands Medicare coverage of diabetes outpatient self-management training. It also requires the Center for Medicare and Medicaid Innovation to test a model in which such training is provided virtually.

To amend title XVIII of the Social Security Act to improve access to 
 diabetes outpatient self-management training services, to require the 
 Center for Medicare and Medicaid Innovation to test the provision of 
virtual diabetes outpatient self-management training services, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives 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 2021''.

SEC. 2. IMPROVING ACCESS TO DIABETES OUTPATIENT SELF-MANAGEMENT 
              TRAINING SERVICES.

    (a) In General.--Section 1861(qq) of the Social Security Act (42 
U.S.C. 1395x(qq)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``the Secretary determines 
                appropriate'' and inserting ``specified in paragraph 
                (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 coordination with the physician 
                or qualified nonphysician practitioner managing such 
                individual's diabetic condition)'' after ``managing the 
                individual's diabetic condition'';
            (2) in paragraph (2)(B), by striking ``paragraph'' and 
        inserting ``subparagraph''; and
            (3) by adding at the end the following new paragraph:
    ``(3) For purposes of paragraph (1), the times specified in this 
paragraph are the following:
            ``(A) An initial 10 hours of educational and training 
        services to remain available until used.
            ``(B) No more than 2 hours of individual or group 
        educational and training services each year, including the year 
        in which the initial 10 hours described in subparagraph (A) are 
        completed.''.
    (b) Medical Nutrition Therapy Services.--Section 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 the Social Security Act (42 
U.S.C. 1395l) is amended--
            (1) in subsection (a)(1)--
                    (A) by striking ``and (DD)'' and inserting 
                ``(DD)''; and
                    (B) by striking the semicolon at the end and 
                inserting ``and (EE) with respect to diabetes 
                outpatient self-management training services (as 
                defined in section 1861(qq)), the 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), in the first sentence--
                    (A) by striking ``and (12)'' and inserting 
                ``(12)''; and
                    (B) by striking the period at the end and inserting 
                ``, and (13) such deductible shall not apply with 
                respect to diabetes outpatient self-management training 
                services (as defined in section 1861(qq)).''
    (d) Application.--The amendments made by this section shall apply 
with respect to items and services furnished on or after January 1, 
2023.

SEC. 3. CMI TESTING OF PROVIDING VIRTUAL DIABETES OUTPATIENT SELF-
              MANAGEMENT TRAINING SERVICES.

    Section 1115A of the Social Security Act (42 U.S.C. 1315a) is 
amended--
            (1) in subsection (b)(2)(A), by adding at the end the 
        following new sentence: ``The models selected under this 
        subparagraph shall include the testing of the model described 
        in subsection (h).''; and
            (2) by adding at the end the following new subsection:
    ``(h) Testing of Providing Virtual Diabetes Outpatient Self-
Management Training Services.--
            ``(1) Establishment.--Not later than January 1, 2023, the 
        Secretary shall implement a model to test the impact of 
        providing coverage under title XVIII for virtual diabetes 
        outpatient self-management training services furnished to 
        applicable beneficiaries with respect to improved health 
        outcomes for such applicable beneficiaries and reduced 
        expenditures under such title XVIII.
            ``(2) Model design.--
                    ``(A) In general.--The Secretary shall design the 
                model under this subsection in such a manner to allow 
                for the evaluation of demographic characteristics of 
                applicable beneficiaries participating in such model 
                and the extent to which such model accomplishes the 
                following purposes:
                            ``(i) Improvement in health outcomes with 
                        respect to the diabetic conditions, including 
                        by reducing A1c levels.
                            ``(ii) Reduced hospitalizations due to 
                        diabetic-related complications.
                            ``(iii) Increased utilization of diabetes 
                        outpatient self-management training services as 
                        evidenced by, for example, Medicare beneficiary 
                        participation and utilization of covered hours 
                        during the first year and subsequent years or 
                        use of diabetes outpatient self-management 
                        training services in rural and underserved 
                        communities.
                            ``(iv) Improved medication adherence.
                            ``(v) Reduced expenditures under this title 
                        attributable to the model.
                    ``(B) Consultation.--In designing the model under 
                this subsection, the Secretary shall, not later than 3 
                months after the date of the enactment of this 
                subsection, consult with stakeholders in the field of 
                diabetes care and education, clinicians in the primary 
                care community, experts in digital health, and 
                beneficiary groups.
            ``(3) Definitions.--In this subsection:
                    ``(A) Applicable beneficiary.--The term `applicable 
                beneficiary' means an individual with diabetes as 
                described in section 1861(qq).
                    ``(B) Qualified web-based program.--The term 
                `qualified web-based program' means a web-based 
                program--
                            ``(i) designed to furnish educational and 
                        training services to an individual with 
                        diabetes to ensure therapy compliance with 
                        respect to the individual's diabetic condition 
                        or to provide the individual with necessary 
                        skills and knowledge (including skills related 
                        to the self-administration of injectable drugs) 
                        to participate in the individual's management 
                        of such condition; and
                            ``(ii) that meets the quality standards 
                        described in section 1861(qq)(2)(B).
                    ``(C) Virtual diabetes outpatient self-management 
                training services.--The term `virtual diabetes 
                outpatient self-management training services' means any 
                diabetes outpatient self-management training services 
                (as defined in section 1861(qq)) furnished by a 
                qualified web-based program for synchronous or 
                asynchronous diabetes outpatient self-management 
                training services.''.
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