,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #ifb  ,,in ,,the ,,house ,,of   
,,representatives  ,march #e1 #bjac     
,mrs4 ,davis of ,california 7for herself
 and ,mr4 ,vela7 introduced the         
following bill2 which was referred to   
the ,committee on ,energy and ,commerce1
 and in addition to the ,committee on   
,ways and ,means1 for a period to be    
subsequently determined by the ,speaker1
 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 reduce the
 incidence of diabetes among ,medicare  
beneficiaries4  #a4 ,short title ,this  
,act may be cited as the ,medicare      
,diabetes ,prevention ,act of #bjac4    
#b4 ,diabetes prevention under the      
,medicare program  7a7 ,coverage of     
diabetes prevention program services    
7#a7 ,coverage of services  7,a7 ,in    
general ,section #ahfa7s77#b7 of the    
,social ,security ,act 7#db ,u4,s4,c4   

#aciex7s77#b77 is amended--  7i7 in     
subparagraph 7,,ee71 by striking and    
after the semicolon at the end2  7ii7 in
 subparagraph 7,,ff71 by inserting and  
after the semicolon at the end2 and     
7iii7 by adding at the end the following
 new subparagraph3  7,,gg7 items and    
services furnished under a diabetes     
prevention program 7as defined in       
subsection 7iii77#a77 to an eligible    
diabetes prevention program individual  
7as defined in subsection 7iii77#b772  4
  7,b7 ,definitions ,section #ahfa of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciex7 is amended by adding  
at the end the following new subsection3
  7iii7 ,diabetes prevention program2   
eligible diabetes prevention program    
individual2 qualified diabetes          
prevention program provider  7#a7 7,a7  
,the term diabetes prevention program   
means a program that--  7i7 meets the   
criteria described in subparagraph 7,b72
 and  7ii7 is furnished by a qualified  
diabetes prevention program provider 7as

 defined in paragraph 7#c77;,a774  7,b7 
,the ,secretary shall establish the     
criteria for a diabetes prevention      
program4 ,such criteria shall be in     
accordance with the standards under the 
,national ,diabetes ,prevention         
,program1 as established by the ,centers
 for ,disease ,control and ,prevention1 
and shall require that the program      
complies with the ,federal regulations  
7concerning the privacy of individually 
identifiable health information7        
promulgated under section #bfd7;c7 of   
the ,health ,insurance ,portability and 
,accountability ,act of #aiif4 ,in      
establishing such criteria1 the         
,secretary may also consider other      
factors or clinical evidence as the     
,secretary determines appropriate4  7,c7
 ,items and services furnished under a  
diabetes prevention program may be      
furnished in a community setting1 as    
defined by the ,secretary4  7,d7 ,the   
,secretary shall establish procedures   
under which a qualified diabetes        

prevention program provider may contract
 with a diabetes prevention program     
delivery partner to furnish the items   
and services under a diabetes prevention
 program4 ,for purposes of this         
subsection1 the term diabetes prevention
 program delivery partner means an      
entity1 including non-profit            
organizations1 public and private       
hospitals1 ,state and local departments 
of public health1 and ,federally        
qualified health centers1 that meets    
criteria established by the ,secretary4 
,such criteria shall be in accordance   
with the standards under the ,national  
,diabetes ,prevention ,program1 as      
established by the ,centers for ,disease
 ,control and ,prevention4 ,in          
establishing such criteria1 the         
,secretary may also consider other      
factors or clinical evidence as the     
,secretary determines appropriate4  7#b7
 7,a7 ,the term eligible diabetes       
prevention program individual means an  
individual at risk for diabetes 7as     

defined in subsection 7yy77#b77 who     
would benefit from items and services   
under a diabetes prevention program1 as 
determined based on criteria established
 by the ,secretary4  7,b7 ,the criteria 
established under subparagraph 7,a7     
shall be in accordance with the         
standards under the ,national ,diabetes 
,prevention ,program1 as established by 
the ,centers for ,disease ,control and  
,prevention4 ,in establishing such      
criteria1 the ,secretary may also       
consider other factors or clinical      
evidence as the ,secretary determines   
appropriate4  7#c7 7,a7 7i7 ,the term   
qualified diabetes prevention program   
provider means any entity1 including a  
,federally qualified health center1 that
 the ,secretary determines--  7,i7 is   
appropriate to furnish items and        
services under a diabetes prevention    
program2 and  7,,ii7 meets criteria     
established by the ,secretary1 in       
consultation with the ,centers for      
,disease ,control and ,prevention4  7ii7

 ,a qualified diabetes prevention       
program provider may be1 as determined  
appropriate by the ,secretary1 a        
supplier 7as defined in subsection 7d771
 a provider of services 7as defined in  
subsection 7u771 a health insurance or  
services company1 a community-based     
organization1 or any other appropriate  
entity4  7,b7 ,a qualified diabetes     
prevention program provider shall--  7i7
 furnish the items and services under   
the diabetes prevention program through 
a delivery partner 7pursuant to         
paragraph 7#a77;,d77 unless no such     
delivery partner is available2  7ii7    
manage and track the outcomes of a      
diabetes prevention program 7including  
attendance and weight loss of           
participating individuals7 through      
defined systems1 including outcomes of  
programs furnished under contract with a
 diabetes prevention program delivery   
partner as defined in paragraph         
7#a77;,d72  7iii7 implement business    
processes to manage program workflow1   

such as eligibility1 reporting1 claims  
billing1 class scheduling1 and          
enrollment2  7iv7 manage and verify     
billing accuracy and beneficiary        
eligibility 7as described in paragraph  
7#b772  7v7 comply with applicable laws 
and regulations and ensure such         
compliance by a diabetes prevention     
program delivery partner2  7vi7 perform 
various forms of engagement with1 and   
outreach to1 eligible diabetes          
prevention program individuals1         
including those participating in        
programs furnished under contract with a
 diabetes prevention program delivery   
partner2  7vii7 comply with all program 
integrity requirements as established by
 the ,secretary2 and  7viii7 perform    
such other functions as established by  
the ,secretary4  4  7#b7 ,amount of     
payment ,section #ahcc7;a77#a7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7a77#a77 is amended--  7,a7 by    
striking and 7,z7 and inserting 7,z72   
and  7,b7 by inserting before the       

semicolon at the end the following3 1   
and 7,,aa7 with respect to items and    
services furnished under a diabetes     
prevention program 7as defined in       
section #ahfa7;iii77#a771 the amount    
paid shall be #ajj percent of 7i7 except
 as provided in clause 7ii71 the lesser 
of the actual charge for the items and  
services or the amount determined under 
the fee schedule that applies to such   
items and services under this part1 as  
determined by the ,secretary1 and 7ii7  
in the case of such items and services  
that are covered ,,opd services 7as     
defined in subsection 7t77#a77;,b771 the
 amount determined under subsection 7t74
  7#c7 ,waiver of application of        
deductible ,the first sentence of       
section #ahcc7;b7 of the ,social        
,security ,act 7#db ,u4,s4,c4 #aciel7b77
 is amended--  7,a7 by striking and     
before 7#aj72 and  7,b7 by inserting    
before the period the following3 1 and  
7#aa7 such deductible shall not apply   
with respect to items and services under

 a diabetes prevention program 7as      
defined in section #ahfa7;iii77#a774    
7#d7 ,assignment of claims ,section     
#ahdb7;b77#ah77;,c7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#acieu7b77#ah77;,c77 is amended by      
adding at the end the following new     
clause3  7vii7 ,a qualified diabetes    
prevention program provider 7as defined 
in section #ahfa7;iii77#c77;,a774  4    
7#e7 ,exclusion of items and services   
under a diabetes prevention program from
 skilled nursing facility prospective   
payment system ,section                 
#ahhh7;e77#b77;,a77ii7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acieyy7e77#b77;,a77ii77 is amended by  
inserting items and services under a    
diabetes prevention program 7as defined 
in section #ahfa7;iii77#a771 after      
qualified psychologist services14  7#f7 
,inclusion in ,federally qualified      
health center services ,section         
#ahfa7;aa77#c7 of the ,social ,security 
,act 7#db ,u4,s4,c4 #aciex7aa77#c77 is  

amended--  7,a7 in subparagraph 7,a71 by
 striking and at the end2  7,b7 in      
subparagraph 7,b71 by striking the comma
 at the end and inserting 2 and2 and    
7,c7 by adding after subparagraph 7,b7  
the following new subparagraph3  7,c7   
items and services under a diabetes     
prevention program 7as defined in       
section #ahfa7;iii77#a771  4  7#g7      
,special consideration for the dual     
eligible population ,in implementing the
 amendments made by this subsection1 the
 ,secretary of ,health and ,human       
,services shall give special            
consideration to the needs of           
individuals who are dually eligible for 
benefits under the ,medicare and        
,medicaid programs4  7#h7 ,evaluation   
and report to congress  7,a7 ,evaluation
 ,the ,secretary of ,health and ,human  
,services shall conduct an evaluation on
 the coverage of items and services     
under a diabetes prevention program     
under the ,medicare program1 as added by
 the amendments made by this subsection4

 ,such evaluation shall include an      
analysis of--  7i7 the impact of the    
provision of such coverage on ,medicare 
beneficiaries1 including the impact on  
various populations1 such as individuals
 who are dually eligible for benefits   
under the ,medicare and ,medicaid       
programs1 and the impact of the         
provision of such coverage on health    
disparities2  7ii7 the rate at which    
physicians refer eligible diabetes      
prevention program individuals to       
diabetes prevention programs under the  
,medicare program2  7iii7 ,medicare     
beneficiary participation levels in     
diabetes prevention programs under the  
,medicare program and the awareness of  
,medicare beneficiaries of the benefit2 
7iv7 the health outcomes resulting from 
completion of a diabetes prevention     
program under the ,medicare program2    
7v7 program integrity protections       
important to diabetes prevention        
programs under the ,medicare program2   
and  7vi7 other areas determined        

appropriate by the ,secretary4  7,b7    
,report ,not later than ,january #a1    
#bjai1 the ,secretary of ,health and    
,human ,services shall submit to        
,congress a report on the evaluation    
conducted under subparagraph 7,a71      
together with recommendations for such  
legislation and administrative actions  
as the ,secretary determines            
appropriate4  7#i7 ,effective date ,the 
amendments made by paragraphs 7#a7      
through 7#f7 shall apply with respect to
 services furnished on or after ,january
 #a1 #bjae4  7b7 ,inclusion of referral 
rates to diabetes prevention programs in
 the medicare physician quality         
reporting system ,section               
#ahdh7k77#b77;,c77i7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7k77#b77;,c77i77 is amended by 
adding at the end the following new     
sentence3 ,for purposes of reporting    
data on quality measures for covered    
professional services furnished during  
#bjah and each subsequent year1 the     

quality measures specified under this   
paragraph shall include a measure with  
respect to referrals of eligible        
diabetes prevention program individuals 
7as defined in paragraph 7#b7 of section
 #ahfa7;iii77 to diabetes prevention    
programs 7as defined in paragraph 7#a7  
of such section744  7c7 ,inclusion of   
diabetes risk assessment in medicare    
personalized prevention plan  7#a7 ,in  
general ,section #ahfa7;hhh77#b77;,c7 of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #aciex7hhh77#b77;,c77 is      
amended by inserting before the period  
at the end the following3 1 and an      
assessment of whether the individual is 
an individual at risk for diabetes 7as  
defined in subsection 7yy77#b774  7#b7  
,effective date ,the amendments made by 
this subsection shall apply to          
personalized prevention plans created or
 updated on or after ,january #a1 #bjae4
  #c4 ,findings2 sense of the ,house of 
,representatives regarding diabetes     
prevention under the ,medicaid program  

7a7 ,findings ,congress makes the       
following findings3  7#a7 ,the          
prevalence and cost of diabetes is a    
significant concern for ,state ,medicaid
 programs4 ,by #bjba1 the ,medicaid     
program is expected to cover #ac1jjj1jjj
 people with diabetes and about         
#i1jjj1jjj people who may have          
pre-diabetes4 ,by #bjba1 ,states will   
spend an estimated #hc1jjj1jjj1jjj on   
individuals with diabetes or            
pre-diabetes4  7#b7 ,the ,national      
,diabetes ,prevention ,program1 as      
established by the ,centers for ,disease
 ,control and ,prevention1 has been     
proven to reduce the onset of diabetes  
in at-risk adults by #eh percent1 using 
a cost-effective1 community-based       
intervention4  7b7 ,sense of the ,house 
of ,representatives ,it is the sense of 
the ,house of ,representatives that the 
,national ,diabetes ,prevention ,program
 presents an opportunity for ,states to 
reduce the incidence of diabetes among  
individuals enrolled in their ,medicaid 

programs4