Diabetes Self Management Training Act of 2005 - Amends title XVIII (Medicare) of the Social Security Act to provide for the recognition of certified diabetes educators as Medicare providers for purposes of diabetes outpatient self-management training services.
Directs the Comptroller General to study and report to Congress on the barriers that exist for individuals with diabetes in accessing diabetes self-management training.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3612 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 3612
To amend title XVIII of the Social Security Act to improve access to
diabetes self management training by designating certified diabetes
educators who are recognized by a nationally recognized certifying body
and who meet the same quality standards set forth for other providers
of diabetes self management training, as certified providers for
purposes of outpatient diabetes self-management training services under
part B of the Medicare Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 28, 2005
Mr. Weldon of Pennsylvania (for himself and Ms. DeGette) introduced 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 improve access to
diabetes self management training by designating certified diabetes
educators who are recognized by a nationally recognized certifying body
and who meet the same quality standards set forth for other providers
of diabetes self management training, as certified providers for
purposes of outpatient diabetes self-management training services under
part B of the Medicare Program.
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 ``Diabetes Self Management Training
Act of 2005''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Diabetes is widely recognized as one of the top public
health threats facing our Nation today. More than 18,000,000
Americans are currently living with diabetes and that number is
expected to double by the year 2050. Diabetes is the sixth
leading cause of death in the United States, causing more than
200,000 deaths each year.
(2) Diabetes occurs in two forms. Type 1 diabetes is caused
by the body's inability to produce insulin, a hormone that
allows glucose to enter and fuel cells. Type 2 diabetes occurs
when the body fails to make enough insulin or fails to properly
use it. Type 1 diabetes typically develops in childhood or
adolescence and accounts for only 5 to 10 percent of cases of
diabetes. Type 2 diabetes accounts for 90 to 95 percent of
diabetes cases and most often appears among people older than
40. It is especially common in the medicare population, as 1 in
5 adults over age 65 has type 2 diabetes.
(3) Diabetes is a costly disease. In 2002, diabetes
accounted for $132,000,000,000 in direct and indirect health
care costs. It is especially costly for the medicare program.
Individuals with diabetes represent approximately 20 percent of
medicare beneficiaries but account for more than 30 percent of
fee-for-service medicare expenditures.
(4) People with type 1 diabetes are required to take daily
insulin injections to stay alive. While some people with type 2
diabetes need daily insulin injections, others with type 2
diabetes can control their diabetes through healthy meal plans,
exercise, and, for some, oral medications. Diabetes self
management training (in this section referred to as ``DSMT''),
also called diabetes education, provides knowledge and skills
training to patients with diabetes, helping them identify
barriers, facilitate problem solving, and develop coping skills
to effectively manage their diabetes. A certified diabetes
educator is a health care professional, often a nurse,
dietitian, or pharmacist, who specializes in helping people
with diabetes develop the self-management skills needed to stay
healthy and avoid costly acute complications and emergency
care, as well as debilitating secondary conditions caused by
diabetes.
(5) DSMT has been proven effective in helping to reduce the
risks and complications of diabetes. In 2002, the Diabetes
Prevention Program study found that participants (all of whom
were at increased risk of developing type 2 diabetes) who made
lifestyle changes, such as those taught in DSMT programs,
reduced their risk of getting type 2 diabetes by 58 percent.
Lifestyle intervention worked in all of the groups but it
worked particularly well in people aged 60 and older, reducing
the development of diabetes by 71 percent. Similarly, studies
have found that patients under the care of a certified diabetes
educator are better able to control their diabetes and report
improvement in their health status. Congress recognized the
value of DSMT by creating medicare coverage for this benefit
under the Balanced Budget Act of 1997.
(6) There are currently more than 20,000 diabetes educators
in the United States, most of whom are certified diabetes
educators credentialed by the National Certification Board for
Diabetes Educators (NCBDE). Eligibility for certification as a
diabetes educator requires prerequisite qualifying professional
credentials in specified health care professions and
professional practice experience that includes a minimum number
of hours of experience in DSMT. Certified diabetes educators
must also pass a rigorous national examination and periodically
renew their credentials. Certified diabetes educators are
uniquely qualified to provide DSMT under the medicare program.
SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDUCATORS AS MEDICARE
PROVIDERS FOR PURPOSES OF 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 (2)--
(A) in subparagraph (A), by inserting ``, or a
certified diabetes educator (as defined in paragraph
(3)) who is credentialed by a nationally recognized
certifying body for diabetes educators'' before the
semicolon at the end; and
(B) in subparagraph (B), by striking ``a
physician'' through ``meets applicable'' and inserting
the following: ``a physician, or such other individual
or entity, or a certified diabetes educator meets the
quality standards described in this paragraph if the
physician, other individual or entity, or certified
diabetes educator meets quality standards established
by the Secretary, except that the physician, other
individual or entity, or certified diabetes educator
shall be deemed to have met such standards if the
physician, other individual or entity, or certified
diabetes educator meets applicable''; and
(2) by adding at the end the following new paragraph:
``(3) For purposes of paragraph (2), the term `certified diabetes
educator' means an individual who--
``(A) is a health care professional who specializes in
helping individuals with diabetes develop the self-management
skills needed to overcome the daily challenges and problems
caused by the disease;
``(B) has met all criteria for initial certification,
including a prerequisite qualifying professional credential in
a specified health care profession, has professional practice
experience in diabetes self-management training that includes a
minimum number of hours of diabetes self-management training,
and has passed a national examination offered by a certifying
body recognized as entitled to grant certification to diabetes
educators; and
``(C) has periodically renewed certification status
following initial certification.''.
(b) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
shall conduct a study to identify the barriers that exist for
individuals with diabetes in accessing diabetes self management
training, including economic and geographic barriers and
availability of appropriate referrals and access to adequate,
qualified providers.
(2) Report.--Not later than 1 year after the date of
enactment of this Act, the Comptroller General of the United
States shall submit a report to Congress regarding the study
conducted under paragraph (1).
(c) Effective Date.--The amendments made by subsection (a) shall
apply to diabetes outpatient self-management training services
furnished on or after the date that is 6 months after the date of
enactment of this Act.
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Introduced in House
Introduced in House
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.
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.
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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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