Medicare Diabetes Self-Management Training Act of 2009 - Amends title XVIII (Medicare) of the Social Security Act to provide for the recognition of state-licensed or -registered health care professionals who are certified diabetes educators as Medicare providers of diabetes outpatient self-management training services.
Directs the Comptroller General to study and report to Congress on the barriers that exist for Medicare beneficiaries with diabetes in accessing diabetes self-management training services under the Medicare program.
Directs the Director of the Agency for Health Care Research and Quality to develop a series of recommendations on effective outreach methods to educate primary care physicians and the public about the benefits of diabetes self-management training.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2425 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 2425
To amend title XVIII of the Social Security Act to improve access to
diabetes self-management training by designating certain certified
diabetes educators as certified providers for purposes of outpatient
diabetes self-management training services under part B of the Medicare
Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 14, 2009
Ms. DeGette (for herself, Mr. Castle, Mr. Kirk, Mr. Becerra, and Mr.
Space) 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 certain certified
diabetes educators 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 ``Medicare Diabetes Self-Management
Training Act of 2009''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Diabetes is widely recognized as one of the top public
health threats currently facing the United States.
Approximately 24,000,000 people in the United States are
currently living with diabetes, and another 57,000,000 people
in the United States have pre-diabetes, dramatically raising
their risk of developing diabetes, heart disease, and stroke.
Three million individuals with diagnosed diabetes receive no
treatment for the disease, and only about 56 percent of those
newly diagnosed with diabetes receive the type of diet and
exercise counseling that are vital components of a diabetes
self management training (DSMT) regimen. The number of
Americans living with diabetes increased 50 percent between
1997-2004, and the Centers for Disease Control projects that
the prevalence of diagnosed diabetes in the U.S. will increase
165 percent by 2050.
(2) Diabetes costs the United States over $174 billion
annually, with $116 billion attributed to direct medical costs
associated with diabetes care, and $58 billion attributed to
indirect costs associated with lost productivity. Eighteen
percent of all Medicare beneficiaries have diabetes, accounting
for 32 percent of Medicare spending.
(3) Diabetes self-management training, also called diabetes
education, provides critical 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.
(4) Diabetes self-management training has been proven
effective in helping to reduce the risks and complications of
diabetes. In 2002, the Diabetes Prevention Program study
conducted by the National Institutes of Health and the Centers
for Disease Control and Prevention found that participants (all
of whom were at increased risk of developing type 2 diabetes)
who made lifestyle changes 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.
(5) Lifestyle changes, such as those taught by certified
diabetes educators, directly contribute to better glycemic
control and reduced complications from diabetes. Evidence shows
that the potential for prevention of the most serious medical
complications caused by diabetes to be as high as 90 percent
(blindness), 85 percent (amputations), and 50 percent (heart
disease and stroke) with proper medical treatment and active
self-management.
(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. Eligibility for certification as a diabetes
educator by the National Certification Board for Diabetes
Educators requires prerequisite qualifying professional
credentials in specific health care professions and
professional practice experience that includes a minimum number
of hours and years of experience in diabetes self-management
training. Diabetes educators certified by the National
Certification Board for Diabetes Educators must also pass a
rigorous national examination and periodically renew their
credentials. Diabetes educators certified by the National
Certification Board for Diabetes Educators, and licensed by a
State as a health professional, are uniquely qualified to
provide diabetes self-management training under the Medicare
program.
(7) Enhancing access to diabetes self-management training
programs that are taught by Certified Diabetes Educators is an
important public policy goal that can help improve health
outcomes, ensure quality, and reduce escalating diabetes-
related health costs.
SEC. 3. RECOGNITION OF CERTIFIED DIABETES EDUCATORS AS CERTIFIED
PROVIDERS FOR PURPOSES OF MEDICARE 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), by inserting ``or by a certified
diabetes educator (as defined in paragraph (3))'' after
``paragraph (2)(B)''; and
(2) by adding at the end the following new paragraphs:
``(3) For purposes of paragraph (1), the term `certified
diabetes educator' means an individual who--
``(A) is licensed or registered by the State in
which the services are performed as a health care
professional;
``(B) specializes in teaching individuals with
diabetes to develop the necessary skills and knowledge
to manage the individual's diabetic condition; and
``(C) is certified as a diabetes educator by a
recognized certifying body (as defined in paragraph
(4)).
``(4)(A) For purposes of paragraph (3)(B), the term
`recognized certifying body' means--
``(i) the National Certification Board for
Diabetes Educators, or
``(ii) a certifying body for diabetes
educators, which is recognized by the Secretary
as authorized to grant certification of
diabetes educators for purposes of this
subsection pursuant to standards established by
the Secretary,
if the Secretary determines such Board or body,
respectively, meets the requirement of subparagraph
(B).
``(B) The National Certification Board for Diabetes
Educators or a certifying body for diabetes educators
meets the requirement of this subparagraph, with
respect to the certification of an individual, if the
Board or body, respectively, is incorporated and
registered to do business in the United States and
requires as a condition of such certification each of
the following:
``(i) The individual has a qualifying
credential in a specified health care
profession.
``(ii) The individual has professional
practice experience in diabetes self-management
training that includes a minimum number of
hours and years of experience in such training.
``(iii) The individual has successfully
completed a national certification examination
offered by such entity.
``(iv) The individual periodically renews
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
Medicare beneficiaries with diabetes in accessing diabetes
self-management training services under the Medicare program,
including economic and geographic barriers and availability of
appropriate referrals and access to adequate and qualified
providers.
(2) Report.--Not later than 1 year after the date of the
enactment of this Act, the Comptroller General of the United
States shall submit to Congress a report on the study conducted
under paragraph (1).
(c) AHRQ Development of Recommendations for Outreach Methods and
Report.--
(1) Development of recommendations.--The Director of the
Agency for Healthcare Research and Quality shall, through use
of a workshop and other appropriate means, develop a series of
recommendations on effective outreach methods to educate
primary care physicians and the public about the benefits of
diabetes self-management training in order to promote better
health outcomes for patients with diabetes.
(2) Report.--Not later than 1 year after the date of the
enactment of this Act, the Director of the Agency for
Healthcare Research and Quality shall submit to Congress a
report on the recommendations developed under paragraph (1).
(d) Effective Date.--The amendments made by subsection (a) shall
apply to diabetes outpatient self-management training services
furnished on or after the first day of the first calendar year that is
at least 6 months after the date of the enactment of this Act.
<all>
Introduced in House
Introduced in House
Referred to House Energy and Commerce
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 House Ways and Means
Referred to the Subcommittee on Health.
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