H.R.4264 - Medicare Diabetes Education and Treatment Amendments of 1996104th Congress (1995-1996)
|Sponsor:||Rep. Nethercutt, George R., Jr. [R-WA-5] (Introduced 09/27/1996)|
|Committees:||House - Commerce; Ways and Means|
|Latest Action:||House - 10/04/1996 Referred to the Subcommittee on Health and Environment. (All Actions)|
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Text: H.R.4264 — 104th Congress (1995-1996)All Information (Except Text)
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Introduced in House (09/27/1996)
[Congressional Bills 104th Congress] [From the U.S. Government Printing Office] [H.R. 4264 Introduced in House (IH)] 104th CONGRESS 2d Session H. R. 4264 To amend title XVIII of the Social Security Act to improve Medicare treatment and education for beneficiaries with diabetes by providing coverage of diabetes outpatient self-management training services and uniform coverage of blood-testing strips for individuals with diabetes. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES September 27, 1996 Mr. Nethercutt (for himself, Mr. Weldon of Pennsylvania, Mr. Gingrich, Mr. Watts of Oklahoma, Mr. Bonilla, and Mr. Bilirakis) introduced the following bill; which was referred to the Committee on 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 Medicare treatment and education for beneficiaries with diabetes by providing coverage of diabetes outpatient self-management training services and uniform coverage of blood-testing strips for individuals with diabetes. 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 Education and Treatment Amendments of 1996''. SEC. 2. MEDICARE COVERAGE OF DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES. (a) In General.--Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended-- (1) by striking ``and'' at the end of subparagraphs (M) and (O), and (2) by inserting after subparagraph (O) the following new subparagraph: ``(R) diabetes outpatient self-management training services (as defined in subsection (oo)); and''. (b) Definition.--Section 1861 of such Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection: ``Diabetes Outpatient Self-management Training Services ``(oo)(1) The term `diabetes outpatient self-management training services' means educational and training services furnished to an individual with diabetes by or under arrangements with a certified provider (as described in paragraph (2)(A)) in an outpatient setting by an individual or entity who meets the quality standards described in paragraph (2)(B), but only if the physician who is managing the individual's diabetic condition certifies that such services are needed under a comprehensive plan of care related to the individual's diabetic condition to provide the individual with necessary skills and knowledge (including skills related to the self-administration of injectable drugs) to participate in the management of the individual's condition. ``(2) In paragraph (1)-- ``(A) a `certified provider' is an individual or entity that, in addition to providing diabetes outpatient self- management training services, provides other items or services for which payment may be made under this title; and ``(B) an individual or entity meets the quality standards described in this paragraph if the individual or entity meets quality standards established by the Secretary, except that the individual or entity shall be deemed to have met such standards if the individual or entity meets applicable standards originally established by the National Diabetes Advisory Board and subsequently revised by organizations who participated in the establishment of standards by such Board, or is recognized by the American Diabetes Association as meeting standards for furnishing the services.''. (c) Consultation With Organizations in Establishing Payment Amounts for Services Provided by Physicians.--In establishing payment amounts under section 1848(a) of the Social Security Act for physicians' services consisting of diabetes outpatient self-management training services, the Secretary of Health and Human Services shall consult with appropriate organizations, including the American Diabetes Association, in determining the relative value for such services under section 1848(c)(2) of such Act. (d) Effective Date.--The amendments made by this section shall apply to services furnished on or after January 1, 1997. SEC. 3. MEDICARE COVERAGE OF BLOOD-TESTING STRIPS FOR INDIVIDUALS WITH DIABETES. (a) Including Strips as Durable Medical Equipment.--Section 1861(n) of the Social Security Act (42 U.S.C. 1395x(n)) is amended by striking the semicolon in the first sentence and inserting the following: ``, and includes blood-testing strips for individuals with diabetes without regard to whether the individual has Type I or Type II diabetes (as determined under standards established by the Secretary in consultation with the American Diabetes Association);''. (b) Payment for Strips Based on Methodology for Inexpensive and Routinely Purchased Equipment.--Section 1834(a)(2)(A) of such Act (42 U.S.C. 1395m(a)(2)(A)) is amended-- (1) by striking ``or'' at the end of clause (ii); (2) by adding ``or'' at the end of clause (iii); and (3) by inserting after clause (iii) the following new clause: ``(iv) which is a blood-testing strip for an individual with diabetes,''. (c) Effective Date.--The amendments made by this section shall apply to blood-testing strips furnished on or after July 1, 1997. <all>