Expanding Access to Diabetes Self-Management Training Act of 2023

I 118TH CONGRESS 1ST SESSION H. R. 3842 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. IN THE HOUSE OF REPRESENTATIVES JUNE 6, 2023 Ms. SCHRIER (for herself, Mr. BILIRAKIS, Ms. DEGETTE, Mr. BUCSHON, Ms. DELBENE, Mr. KELLY of Pennsylvania, Mr. RUIZ, and Mr. SCHWEIKERT) 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 outpatient self-management training services, to require the Center for Medicare and Medicaid Innovation to test the provision of virtual diabetes out- patient self-management training services, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 04:17 Jun 27, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3842.IH H3842 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3842 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Expanding Access to 2 Diabetes Self-Management Training Act of 2023’’. 3 SEC. 2. IMPROVING ACCESS TO DIABETES OUTPATIENT 4 SELF-MANAGEMENT TRAINING SERVICES. 5 (a) IN GENERAL.—Section 1861(qq) of the Social Se- 6 curity Act (42 U.S.C. 1395x(qq)) is amended— 7 (1) in paragraph (1)— 8 (A) by striking ‘‘the Secretary determines 9 appropriate’’ and inserting ‘‘specified in para- 10 graph (3)’’; 11 (B) by inserting ‘‘or qualified nonphysician 12 practitioner’’ after ‘‘only if the physician’’; and 13 (C) by inserting ‘‘(or other physician or 14 qualified nonphysician practitioner furnishing 15 items or services to such individual, in coordina- 16 tion with the physician or qualified nonphysi- 17 cian practitioner managing such individual’s di- 18 abetic condition)’’ after ‘‘managing the individ- 19 ual’s diabetic condition’’; 20 (2) in paragraph (2)(B), by striking ‘‘para- 21 graph’’ and inserting ‘‘subparagraph’’; and 22 (3) by adding at the end the following new 23 paragraph: 24 ‘‘(3) For purposes of paragraph (1), the times speci- 25 fied in this paragraph are the following: 26 VerDate Sep 11 2014 04:17 Jun 27, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3842.IH H3842 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3842 IH ‘‘(A) An initial 10 hours of educational and 1 training services to remain available until used. 2 ‘‘(B) No more than 2 hours of individual or 3 group educational and training services each year, 4 including the year in which the initial 10 hours de- 5 scribed in subparagraph (A) are completed.’’. 6 (b) MEDICAL NUTRITION THERAPY SERVICES.—Sec- 7 tion 1861(s)(2)(V) of such Act (42 U.S.C. 8 1395x(s)(2)(V)) is amended— 9 (1) by striking clause (i); 10 (2) by redesignating clauses (ii) and (iii) as 11 clauses (i) and (ii), respectively; and 12 (3) in clause (ii), as so redesignated, by striking 13 ‘‘after consideration of’’ and inserting ‘‘consistent 14 with’’. 15 (c) COST-SHARING.—Section 1833 of the Social Se- 16 curity Act (42 U.S.C. 1395l) is amended— 17 (1) in subsection (a)(1)— 18 (A) by striking ‘‘and (HH)’’ and inserting 19 ‘‘(HH)’’; and 20 (B) by inserting the following before the 21 semicolon at the end: ‘‘and (II) with respect to 22 diabetes outpatient self-management training 23 services (as defined in section 1861(qq)), the 24 amount paid shall be 100 percent of the lesser 25 VerDate Sep 11 2014 04:17 Jun 27, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3842.IH H3842 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3842 IH of the actual charge for the services or the 1 amount determined under the fee schedule that 2 applies to such services under this part;’’; and 3 (2) in subsection (b), in the first sentence— 4 (A) by striking ‘‘, and (13)’’ and inserting 5 ‘‘(13)’’; and 6 (B) by striking the period at the end and 7 inserting ‘‘, and (14) such deductible shall not 8 apply with respect to diabetes outpatient self- 9 management training services (as defined in 10 section 1861(qq))’’. 11 (d) APPLICATION.—The amendments made by this 12 section shall apply with respect to items and services fur- 13 nished on or after January 1, 2025. 14 SEC. 3. CMI TESTING OF PROVIDING VIRTUAL DIABETES 15 OUTPATIENT SELF-MANAGEMENT TRAINING 16 SERVICES. 17 Section 1115A of the Social Security Act (42 U.S.C. 18 1315a) is amended— 19 (1) in subsection (b)(2)(A), by adding at the 20 end the following new sentence: ‘‘The models se- 21 lected under this subparagraph shall include the 22 testing of the model described in subsection (h).’’; 23 and 24 VerDate Sep 11 2014 04:17 Jun 27, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3842.IH H3842 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3842 IH (2) by adding at the end the following new sub- 1 section: 2 ‘‘(h) TESTING OF PROVIDING VIRTUAL DIABETES 3 OUTPATIENT SELF-MANAGEMENT TRAINING SERV- 4 ICES.— 5 ‘‘(1) ESTABLISHMENT.—Not later than Janu- 6 ary 1, 2025, the Secretary shall implement a model 7 to test the impact of providing coverage under title 8 XVIII for virtual diabetes outpatient self-manage- 9 ment training services furnished to applicable bene- 10 ficiaries with respect to improved health outcomes 11 for such applicable beneficiaries and reduced expend- 12 itures under such title XVIII. 13 ‘‘(2) MODEL DESIGN.— 14 ‘‘(A) IN GENERAL.—The Secretary shall 15 design the model under this subsection in such 16 a manner to allow for the evaluation of demo- 17 graphic characteristics of applicable bene- 18 ficiaries participating in such model and the ex- 19 tent to which such model accomplishes the fol- 20 lowing purposes: 21 ‘‘(i) Improvement in health outcomes 22 with respect to the diabetic conditions, in- 23 cluding by reducing A1c levels. 24 VerDate Sep 11 2014 04:17 Jun 27, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3842.IH H3842 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 3842 IH ‘‘(ii) Reduced hospitalizations due to 1 diabetic-related complications. 2 ‘‘(iii) Increased utilization of diabetes 3 outpatient self-management training serv- 4 ices as evidenced by, for example, Medicare 5 beneficiary participation and utilization of 6 covered hours during the first year and 7 subsequent years or use of diabetes out- 8 patient self-management training services 9 in rural and underserved communities. 10 ‘‘(iv) Improved medication adherence. 11 ‘‘(v) Reduced expenditures under this 12 title attributable to the model. 13 ‘‘(B) CONSULTATION.—In designing the 14 model under this subsection, the Secretary 15 shall, not later than 3 months after the date of 16 the enactment of this subsection, consult with 17 stakeholders in the field of diabetes care and 18 education, clinicians in the primary care com- 19 munity, experts in digital health, and bene- 20 ficiary groups. 21 ‘‘(3) DEFINITIONS.—In this subsection: 22 ‘‘(A) APPLICABLE BENEFICIARY.—The 23 term ‘applicable beneficiary’ means an indi- 24 VerDate Sep 11 2014 04:17 Jun 27, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3842.IH H3842 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 3842 IH vidual with diabetes as described in section 1 1861(qq). 2 ‘‘(B) QUALIFIED WEB-BASED PROGRAM.— 3 The term ‘qualified web-based program’ means 4 a web-based program— 5 ‘‘(i) designed to furnish educational 6 and training services to an individual with 7 diabetes to ensure therapy compliance with 8 respect to the individual’s diabetic condi- 9 tion or to provide the individual with nec- 10 essary skills and knowledge (including 11 skills related to the self-administration of 12 injectable drugs) to participate in the indi- 13 vidual’s management of such condition; 14 and 15 ‘‘(ii) that meets the quality standards 16 described in section 1861(qq)(2)(B). 17 ‘‘(C) VIRTUAL DIABETES OUTPATIENT 18 SELF-MANAGEMENT TRAINING SERVICES.—The 19 term ‘virtual diabetes outpatient self-manage- 20 ment training services’ means any diabetes out- 21 patient self-management training services (as 22 defined in section 1861(qq)) furnished by a 23 qualified web-based program for synchronous or 24 VerDate Sep 11 2014 04:17 Jun 27, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3842.IH H3842 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 3842 IH asynchronous diabetes outpatient self-manage- 1 ment training services.’’. 2 Æ VerDate Sep 11 2014 04:17 Jun 27, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\H3842.IH H3842 kjohnson on DSK79L0C42PROD with BILLS