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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4094 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 4094
To amend title XVIII of the Social Security Act to provide for coverage
of the Medicare Diabetes Prevention program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 10, 2024
Mr. Scott of South Carolina (for himself, Mr. Warner, and Mr. Cramer)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for coverage
of the Medicare Diabetes Prevention program, 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 ``Promoting Responsible and Effective
Virtual Experiences through Novel Technology to Deliver Improved Access
and Better Engagement with Tested and Evidence-based Strategies Act''
or the ``PREVENT DIABETES Act''.
SEC. 2. MEDICARE DIABETES PREVENTION PROGRAM.
(a) Coverage.--
(1) In general.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended--
(A) in subsection (s)(2), by adding at the end the
following new subparagraph:
``(KK) diabetes prevention program services (as defined in
subsection (nnn));''; and
(B) by adding at the end the following new
subsection:
``(nnn) Diabetes Prevention Program Services.--
``(1) In general.--The term `diabetes prevention program
services' means structured behavioral health change sessions
that--
``(A) are furnished to an eligible individual
described in paragraph (2) by a diabetes prevention
program supplier for the purpose of preventing or
delaying the onset of type II diabetes;
``(B) follow a CDC-approved curriculum; and
``(C) are furnished on or after January 1, 2025.
``(2) Eligible individual described.--An eligible
individual described in this paragraph is an individual that--
``(A) is entitled to benefits under part A and is
enrolled under part B;
``(B) has no previous diagnosis of diabetes (other
than gestational diabetes);
``(C) does not have end-stage renal disease; and
``(D) meets additional medical criteria specified
by the Secretary.
``(3) No lifetime limit on participation.--There shall be
no limitation on the number of times an eligible individual may
enroll in the diabetes prevention program.''.
(2) Conforming change.--Section 1862(a)(1) of the Social
Security Act (42 U.S.C. 1395y(a)(1)) is amended--
(A) in subparagraph (O), by striking ``and'' at the
end;
(B) in subparagraph (P), by striking the semicolon
at the end and inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(Q) in the case of diabetes prevention program services
(as defined in section 1861(nnn)(1)), which are furnished to an
individual who is not an eligible individual (as defined in
section 1861(nnn)(2));''.
(b) Diabetes Prevention Program Suppliers.--Section 1866 of the
Social Security Act (42 U.S.C. 1395cc) is amended by adding at the end
the following new subsection:
``(l) Diabetes Prevention Program Suppliers.--
``(1) Diabetes prevention program supplier.--In this
subsection, the term `diabetes prevention program supplier'
means an entity that--
``(A) is recognized under the Centers for Disease
Control and Prevention Diabetes Prevention Recognition
Program and offers a program through an allowable
Diabetes Prevention Recognition Program delivery mode
including in-person, online, distance learning,
combination, and other synchronous and asynchronous
modalities as determined by the Secretary;
``(B) is enrolled under the diabetes prevention
program in accordance with paragraph (2); and
``(C) meets the requirements described in paragraph
(2)(B).
``(2) Enrollment in diabetes prevention program.--
``(A) Application.--An entity seeking to enroll as
a diabetes prevention program supplier under this
section shall submit to the Secretary an application
for enrollment at such time and in such manner as
specified by the Secretary. Such application must meet
all elements as specified by the Secretary.
``(B) Requirements.--
``(i) Administrative requirements.--Each
diabetes prevention program supplier shall
maintain--
``(I) administrative requirements
as outlined by the Secretary;
``(II) active enrollment as a
diabetes prevention program supplier
under subsection (j); and
``(III) at least one administrative
location.
``(ii) Documentation; data submission.--
``(I) Documentation.--Each diabetes
prevention program supplier shall
maintain documentation in accordance
with standards specified by the
Secretary.
``(II) Data submission.--Each
diabetes prevention program supplier
shall maintain information as specified
by the Secretary and submit it to the
Secretary in the form and manner
specified by the Secretary.
``(iii) Inspection and review
requirements.--Each diabetes prevention program
supplier shall allow the Secretary, or any
person or organization designated by the
Secretary, to conduct inspections of any
administrative location of a diabetes
prevention program supplier, or of any eligible
setting in which diabetes prevention program
services are furnished, as well as review all
documentation and records maintained by such
supplier for purposes of the diabetes
prevention program.
``(C) Diabetes prevention program supplier
termination.--The Secretary may terminate the
enrollment of a diabetes prevention program supplier
for purposes of participation in the diabetes
prevention program if such supplier--
``(i) fails to meet the requirements
described in subparagraph (B);
``(ii) improperly denies services to an
eligible individual (as defined in section
1861(nnn)(2)), including a denial on the basis
of an eligible individual's weight, health
status, or achievement of performance goals; or
``(iii) fails to comply with additional
standards established by the Secretary.
``(3) Administrative location defined.--In this subsection,
the term `administrative location' means a physical location in
which a diabetes prevention program supplier is the primary
operator of such location or the location from which the
diabetes prevention program supplier's business is run in the
case of an online or combination program, and where in-person
diabetes prevention program services may or may not be
furnished.''.
(c) Payment for Diabetes Prevention Program Services.--
(1) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and (HH)'' and inserting
``(HH)''; and
(B) in subparagraph (HH), by striking the semicolon
at the end and inserting the following: ``, and (II)
with respect to diabetes prevention program services
furnished on or after January 1, 2025, as described in
section 1861(nnn), the amount paid shall be equal to
100 percent of the payment amount established in the
payment structure described in section 1834(aa);''.
(2) Payment structure.--Section 1834 of the Social Security
Act (42 U.S.C. 1395m) is amended by adding at the end the
following subsection:
``(aa) Payment for Diabetes Prevention Program Services.--
``(1) In general.--The Secretary shall establish an
appropriate payment structure under which the Secretary shall
make payments to a diabetes prevention program supplier for
diabetes prevention program services furnished to an eligible
individual (as defined in section 1861(nnn)(2)).
``(2) Annual update.--The Secretary shall update the
payment structure under this subsection annually by the
percentage increase in the Consumer Price Index for all urban
consumers (all items; United States city average) for the 12-
month period ending with June of the preceding year.
``(3) Termination of participation.--
``(A) In general.--A diabetes prevention program
supplier may terminate the participation of an
individual participating in the diabetes prevention
program if the individual is no longer an eligible
individual (as defined in section 1862(nnn)(2)).
``(B) Documentation supporting termination.--In the
case of a diabetes prevention program supplier that
terminates the participation of an individual
participating in the diabetes prevention program, such
supplier shall maintain records supporting such
termination, including the date of the termination, the
reason for the termination, the details of any
incidents leading to such termination, any remediation
efforts taken by such supplier, and any final actions
taken by such supplier.
``(4) Continuation of medicare diabetes prevention program
expanded model standards.--Except as specified otherwise in
this Act, the Secretary shall extend the standards of the
Medicare Diabetes Prevention Program Expanded Model (in effect
as of the date of enactment of the PREVENT DIABETES Act) to
govern the diabetes prevention program.
``(5) Diabetes prevention program.--In this subsection, the
term `diabetes prevention program' means the payment structure
described in this subsection.''.
SEC. 3. SUNSET OF MDPP EXPANDED MODEL.
No payment shall be made for services furnished under the Medicare
Diabetes Prevention Program Expanded Model conducted under section
1115A of the Social Security Act (42 U.S.C. 1315a) after January 1,
2025.
SEC. 4. UPDATE TO REGULATIONS.
Not later than November 30, 2024, the Secretary of Health and Human
Services shall update the regulations in sections 410.79, 414.84,
424.200, and 424.205 of title 42, Code of Federal Regulations, and any
other relevant regulations, in accordance with sections 2 and 3 of this
Act.
SEC. 5. REPORT.
Not later than January 1, 2028, the Secretary of Health and Human
Services shall submit to Congress a report on the diabetes prevention
program. Such report shall include a description of the impact of such
program on--
(1) participation of eligible individuals and diabetes
prevention program suppliers in the diabetes prevention program
as compared to the Medicare Diabetes Prevention Program
Expanded Model;
(2) weight loss among eligible individuals;
(3) health outcomes of eligible individuals; and
(4) diagnoses and costs relating to type 2 diabetes for
eligible individuals who have received diabetes prevention plan
services versus those who have not.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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