Preventing Diabetes in Medicare Act of 2019

II 116TH CONGRESS 1ST SESSION S. 2905 To amend title XVIII of the Social Security Act to reduce the occurrence of diabetes in Medicare beneficiaries by extending coverage under Medi- care for medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes. IN THE SENATE OF THE UNITED STATES NOVEMBER 20, 2019 Mr. PETERS (for himself and Mrs. CAPITO) 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 reduce the occurrence of diabetes in Medicare beneficiaries by extending coverage under Medicare for medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Preventing Diabetes 4 in Medicare Act of 2019’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 00:17 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2905.IS S2905 dlhill on DSKBBY8HB2PROD with BILLS 2 •S 2905 IS (1) According to the Centers for Disease Con- 1 trol and Prevention, there are more than 84,000,000 2 adults with pre-diabetes in the United States. The 3 Centers estimates that 48 percent of adults who are 4 65 years of age or older have pre-diabetes. Fewer 5 than 12 percent of adults with pre-diabetes have 6 been told by a doctor that they have it. 7 (2) For a significant number of people with 8 pre-diabetes, early intervention can reverse elevated 9 blood glucose levels to normal range and prevent di- 10 abetes and its complications completely or can sig- 11 nificantly delay its onset. According to the Institute 12 for Alternative Futures, if 50 percent of adults with 13 pre-diabetes were able to successfully make lifestyle 14 changes proven to prevent or delay diabetes, then by 15 2025 approximately 4,700,000 new cases of diabetes 16 could be prevented at a cost savings of $300 billion. 17 (3) Preventing diabetes and its complications 18 can save money and lives. The average annual cost 19 to treat someone with diabetes is $16,752, which is 20 2.3 times higher than average costs for someone who 21 does not have diabetes. The United States spends 22 $327 billion per year on costs associated with diabe- 23 tes, with government insurance including Medicare 24 covering over 2⁄3 of these costs. 25 VerDate Sep 11 2014 00:17 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2905.IS S2905 dlhill on DSKBBY8HB2PROD with BILLS 3 •S 2905 IS (4) Diabetes is unique because its complications 1 and their associated health care costs are often pre- 2 ventable with currently available medical treatment 3 and lifestyle changes. 4 (5) A recent systematic review conducted by the 5 Academy of Nutrition and Dietetics Evidence Anal- 6 ysis Library concluded that randomized clinical 7 trials involving medical nutrition therapy resulted in 8 a significant decrease in waist circumference, fasting 9 blood glucose, and two-hour post prandial blood glu- 10 cose, which is graded as strong evidence of having 11 a lower risk of developing type 2 diabetes. A second, 12 independent systematic review of diabetes prevention 13 using nutrition therapy conducted in Europe found 14 that individuals who received the lifestyle interven- 15 tions had a 47-percent reduced risk of developing 16 type 2 diabetes. 17 (6) The Medicare program currently provides 18 coverage for screening and identifying beneficiaries 19 with pre-diabetes but does not provide adequate 20 services to such beneficiaries to help them prevent or 21 delay the onset of diabetes. 22 VerDate Sep 11 2014 00:17 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2905.IS S2905 dlhill on DSKBBY8HB2PROD with BILLS 4 •S 2905 IS SEC. 3. MEDICARE COVERAGE OF MEDICAL NUTRITION 1 THERAPY SERVICES FOR PEOPLE WITH PRE- 2 DIABETES AND RISK FACTORS FOR DEVEL- 3 OPING TYPE 2 DIABETES. 4 (a) IN GENERAL.—Section 1861 of the Social Secu- 5 rity Act (42 U.S.C. 1395x) is amended— 6 (1) in subsection (s)(2)(V), by striking ‘‘a bene- 7 ficiary with diabetes or a renal disease’’ and insert- 8 ing ‘‘an individual with diabetes, pre-diabetes (as de- 9 fined in subsection (yy)(4)), or a renal disease, or an 10 individual at risk for diabetes (as defined in sub- 11 section (yy)(2)),’’ in the matter preceding clause (i); 12 and 13 (2) in subsection (yy)— 14 (A) in the heading, by adding ‘‘; Pre-Dia- 15 betes’’ at the end; and 16 (B) by adding at the end the following new 17 paragraph: 18 ‘‘(4) The term ‘pre-diabetes’ means a condition of im- 19 paired fasting glucose or impaired glucose tolerance identi- 20 fied by a blood glucose level that is higher than normal, 21 but not so high as to indicate actual diabetes.’’. 22 (b) EFFECTIVE DATE.—The amendments made by 23 this section shall apply with respect to services furnished 24 on or after January 1, 2021. 25 Æ VerDate Sep 11 2014 00:17 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\S2905.IS S2905 dlhill on DSKBBY8HB2PROD with BILLS