,,ib  ,union ,cal5d> ,no4 #fbe  #aad?   
,,congress  #b;d ,session  ,h4 ,r4 #aaib
  ,report ,no4 #aad-hja  ,,9 ,,! ,,h\se 
,,( ,,repres5tatives  ,m>* #b1 #bjae    
,mr4 ,olson 7= himself1 ,mr4 ,loebsack1 
,mr4 ,:itfield1 ,ms4 ,de,gette1 ,ms4    
,norton1 ,mr4 ,f>5?old1 ,mr4 ,kelly (   
,p5nsylvania1 ,mr4 ,gu?rie1 ,mr4        
,takano1 ,mr4 ,bi%op ( ,georgia1 ,mr4   
,blum5au]1 ,mr4 ,grijalva1 ,mr4 ,heck ( 
,nevada1 ,ms4 ,frankel ( ,florida1 ,mr4 
,coll9s ( ,new ,york1 ,mr4 ,mc,kinley1  
,mr4 ,sessions1 ,mr4 ,smi? ( ,new       
,j]sey1 ,mr4 ,rodney ,davis ( ,ill9ois1 
,mr4 ,duncan ( ,s\? ,c>ol9a1 ,mr4 ,lev91
 ,mr4 ,joyce1 ,mr4 ,neal1 ,ms4          
,slaught]1 ,ms4 ,grang]1 ,mr4 ,s*iff1   
,mr4 ,ru%1 ,ms4 ,br[n ( ,florida1 ,mr4  
,b>letta1 ,mr4 ,buc%on1 ,mr4 ,bu*anan1  
,mr4 ,david ,scott ( ,georgia1 ,ms4     
,spei]1 ,ms4 ,edw>ds1 ,mr4 ,long1 ,mr4  
,ha/+s1 ,ms4 ,del,bene1 ,ms4 ,titus1    
,mr4 ,lip9ski1 ,mr4 ,wittman1 ,mr4 ,"y (
 ,indiana1 ,ms4 ,bordallo1 ,mr4 ,y>mu?1 
,mr4 ,butt]field1 ,mr4 ,himes1 ,mr4     

,rangel1 ,ms4 ,ca/or ( ,florida1 ,mr4   
,johnson ( ,ohio1 ,mr4 ,delaney1 ,mr4   
,smi? ( ,texas1 ,mr4 ,pet]s1 ,mr4       
,pet]son1 ,mr4 ,ruiz1 & ,mr4 ,burgess7  
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce      
,novemb] #ad1 #bjaf ,additional         
sponsors3 ,mr4 ,polis1 ,mr4 ,c>twright1 
,ms4 ,tsongas1 ,mr4 ,mc,govern1 ,mr4    
,gohm]t1 ,ms4 ,mc,collum1 ,mr4 ,roe (   
,t5nessee1 ,mr4 ,price ( ,nor? ,c>ol9a1 
,mr4 ,higg9s1 ,mrs4 ,beatty1 ,mr4 ,g[dy1
 ,mr4 ,walz1 ,mr4 ,"y ( ,i[a1 ,ms4      
,matsui1 ,mr4 ,v>gas1 ,mr4 ,pompeo1     
,mrs4 ,bu/os1 ,mr4 ,wilson ( ,s\?       
,c>ol9a1 ,mr4 ,b>r1 ,mr4 ,kildee1 ,ms4  
,ku/]1 ,mr4 ,amodei1 ,mr4 ,tib]i1 ,mr4  
,=t5b]ry1 ,ms4 ,br[nley ( ,cali=nia1    
,mr4 ,/iv]s1 ,mr4 ,huffman1 ,mr4        
,frel+huys51 ,mr4 ,nolan1 ,mr4 ,"y (    
,alaska1 ,mr4 ,pauls51 ,mr4 ,rog]s (    
,k5tucky1 ,mr4 ,turn]1 ,mr4 ,williams1  
,mr4 ,jolly1 ,mr4 ,latta1 ,mr4 ,pocan1  
,mr4 ,m\lton1 ,ms4 ,lee1 ,mr4 ,mooney ( 
,we/ ,virg9ia1 ,mrs4 ,brooks ( ,indiana1

 ,mrs4 ,ellm]s ( ,nor? ,c>ol9a1 ,ms4    
,cl>ke ( ,new ,york1 ,mr4 ,ryan ( ,ohio1
 ,mr4 ,h>p]1 ,ms4 ,p+ree1 ,mr4 ,all51   
,mr4 ,connolly1 ,mr4 ,k9d1 ,mr4 ,lance1 
,mr4 ,ro?fus1 ,mr4 ,tonko1 ,mr4 ,israel1
 ,mrs4 ,h>tzl]1 ,mr4 ,pascrell1 ,ms4    
,s*ak[sky1 ,mr4 ,heck ( ,wa%+ton1 ,mrs4 
,kirkpatrick1 ,mr4 ,re$1 ,mr4 ,payne1   
,ms4 ,cl>k ( ,massa*usetts1 ,mr4 ,coh51 
,mr4 ,veasey1 ,mr4 ,co/ello (           
,p5nsylvania1 ,mrs4 ,watson ,coleman1   
,mr4 ,culb]son1 ,mr4 ,h5s>l+1 ,mr4      
,sablan1 ,mr4 ,flores1 ,ms4 ,eddie      
,b]nice ,johnson ( ,texas1 ,mrs4        
,napolitano1 ,mr4 ,meehan1 ,mr4 ,g5e    
,gre5 ( ,texas1 ,ms4 ,e%oo1 ,mr4 ,c>son 
( ,indiana1 ,ms4 ,max9e ,wat]s (        
,cali=nia1 ,mr4 ,johnson ( ,georgia1    
,mr4 ,bilirakis1 ,mrs4 ,blackburn1 ,mr4 
,k5n$y1 ,mr4 ,gu9ta1 ,mr4 ,=bes1 ,mr4   
,takai1 ,mr4 ,de,fazio1 ,ms4 ,s9ema1    
,mr4 ,lyn*1 ,ms4 ,l(gr51 ,mr4 ,ribble1  
,mr4 ,s5s5br5n]1 ,mr4 ,b5 ,ray ,lujn (  
,new ,mexico1 ,mr4 ,ross1 ,ms4 ,sewell (
 ,alabama1 ,mr4 ,wel*1 ,mr4 ,rigell1    

,mr4 ,?ompson ( ,mississippi1 ,mr4      
,langev91 ,mr4 ,hunt]1 ,mr4 ,yod]1 ,mr4 
,%imkus1 ,mr4 ,s*rad]1 ,ms4 ,judy ,*u ( 
,cali=nia1 ,mr4 ,gutirrez1 ,mr4 ,w5/rup1
 ,mr4 ,k+ ( ,new ,york1 ,mr4 ,mull91    
,mr4 ,sam ,johnson ( ,texas1 ,mr4       
,kilm]1 ,mr4 ,gibson1 ,mrs4 ,davis (    
,cali=nia1 ,mr4 ,lewis1 ,ms4 ,l9da ,t4  
,sn*ez ( ,cali=nia1 ,mr4 ,sires1 ,mr4   
,honda1 ,mr4 ,grayson1 ,mr4 ,pi]luisi1  
,mr4 ,b>ton1 ,mr4 ,rupp]sb]g]1 ,mr4     
,murphy ( ,p5nsylvania1 ,mr4 ,%u/]1 ,mr4
 ,k9z+] ( ,ill9ois1 ,mr4 ,fattah1 ,ms4  
,wilson ( ,florida1 ,mr4 ,nug5t1 ,mr4   
,rokita1 ,ms4 ,kaptur1 ,mr4 ,?ornb]ry1  
,mr4 ,fitzpatrick1 ,mr4 ,swalwell (     
,cali=nia1 ,mr4 ,duncan ( ,t5nessee1    
,mr4 ,deut*1 ,mr4 ,jones1 ,mr4 ,p]ry1   
,mr4 ,zeld91 ,mr4 ,scott ( ,virg9ia1    
,mr4 ,van ,holl51 ,mrs4 ,mill] (        
,mi*igan1 ,mr4 ,r\z]1 ,mr4 ,cony]s1 ,mr4
 ,walb]g1 ,mr4 ,brady ( ,p5nsylvania1   
,mr4 ,bab91 ,miss ,rice ( ,new ,york1   
,ms4 ,velzquez1 ,mr4 ,blum1 ,mr4 ,wald51
 ,mr4 ,a%=d1 ,mr4 ,g>rett1 ,mrs4        

,com/ock1 ,mr4 ,bey]1 ,ms4 ,hahn1 ,mr4  
,cumm+s1 ,mr4 ,?ompson ( ,p5nsylvania1  
,mr4 ,hold+1 ,mr4 ,vela1 ,mr4 ,m>*ant1  
,mrs4 ,lawr5ce1 ,mr4 ,nadl]1 ,mr4       
,valadao1 ,ms4 ,m5g1 ,mr4 ,s]rano1 ,mr4 
,sean ,patrick ,maloney ( ,new ,york1   
,mr4 ,b5i%ek1 ,ms4 ,roybal-,all>d1 ,mr4 
,graves ( ,l\isiana1 ,mr4 ,br5dan ,f4   
,boyle ( ,p5nsylvania1 ,mr4 ,c>t] (     
,texas1 ,ms4 ,mi*elle ,lujan ,gri%am (  
,new ,mexico1 ,mr4 ,byrne1 ,mr4 ,t$     
,lieu ( ,cali=nia1 ,mr4 ,gro?man1 ,ms4  
,adams1 ,mr4 ,doggett1 ,mr4 ,aguil>1    
,mr4 ,lo,biondo1 ,mr4 ,cram]1 & ,mr4    
,rice ( ,s\? ,c>ol9a  ,novemb] #ad1     
#bjaf ,report$ ) am5dm5ts1 committ$ to !
 ,committee ( ! ,:ole ,h\se on ! ,/ate (
 ! ,union1 & ord]$ to be pr9t$ ,/rike   
out all aft] ! enact+ clause & ins]t !  
"p pr9t$ 9 italic ,= text ( introduc$   
bill1 see copy ( bill z introduc$ on    
,m>* #b1 #bjae  ,a ,,bill  ,to am5d !   
,public ,heal? ,s]vice ,act to fo/] m   
effective implem5tation & coord9ation ( 
cl9ical c>e = p ) pre-diabetes1         

diabetes1 & ! *ronic diseases &         
conditions t result f diabetes4  #a4    
,%ort title ,?is ,act may be cit$ z !   
,national ,cl9ical ,c>e ,commission     
,act4  #b4 ,e/abli%m5t ( ! ,national    
,cl9ical ,c>e ,commission ,"p ,p ( title
 ,,iii ( ! ,public ,heal? ,s]vice ,act  
7#db ,u4,s4,c4 #bhj;g et seq47 is am5d$ 
by add+ at ! end ! foll[+ new section3  
#cii,v-#g4 ,national cl9ical c>e        
commission  7a7 ,e/abli%m5t ,!re is     
h]eby e/abli%$1 )9 ! ,dep>tm5t ( ,heal? 
& ,human ,s]vices1 a ,national ,cl9ical 
,c>e ,commission 79 ?is section ref]r$  
to z ! ,commission7 to evaluate1 &      
recomm5d solutions reg>d+ bett]         
coord9ation & lev]ag+ (1 programs )9 !  
,dep>tm5t & o!r ,f$]al ag5cies t relate 
9 any way to support+ appropriate       
cl9ical c>e 7su* z any int]actions      
betwe5 physicians & o!r heal? c>e       
provid]s & _! pati5ts relat$ to treatm5t
 & c>e managem5t7 = individuals )-- 7#a7
 a complex metabolic or autoimmune      
disease2  7#b7 a disease result+ f      

insul9 defici5cy or insul9 resi/ance2 or
  7#c7 complications caus$ by any su*   
disease4  7b7 ,memb]%ip  7#a7 ,9 g5]al  
,! ,commission %all be compos$ ( !      
foll[+ vot+ memb]s3 7,a7 ,! heads 7or _!
 designees7 ( ! foll[+ ,f$]al ag5cies & 
dep>tm5ts3  7i7 ,! ,c5t]s = ,m$ic>e     
,m$icaid ,s]vices4  7ii7 ,! ,ag5cy =    
,heal?c>e ,rese>* & ,quality4  7iii7 ,! 
,c5t]s = ,disease ,control & ,prev5tion4
  7iv7 ,! ,indian ,heal? ,s]vice4  7v7  
,! ,dep>tm5t ( ,vet]ans ,affairs4  7vi7 
,! ,national ,in/itutes ( ,heal?4  7vii7
 ,! ,food & ,drug ,adm9i/ration4  7viii7
 ,! ,heal? ,res\rces & ,s]vices         
,adm9i/ration4  7ix7 ,! ,dep>tm5t (     
,def5se4  7,b7 ,twelve additional vot+  
memb]s appo9t$ "u p>agraph 7#b74  7,c7  
,su* additional vot+ memb]s z may be    
appo9t$ by ! ,secret>y1 at ! ,secret>y's
 discretion1 f among ! heads 7or _!     
designees7 ( gov]nm5tal or nongov]nm5tal
 entities t impact cl9ical c>e (        
individuals ) any ( ! diseases &        
complications describ$ 9 subsection 7a74

  7#b7 ,additional memb]s ,! ,commission
 %all include additional vot+ memb]s    
appo9t$ by ! ,secret>y1 9 consultation )
 national m$ical societies & pati5t     
advocacy organizations ) exp]tise 9 !   
c>e & epidemiology ( any ( ! diseases & 
complications describ$ 9 subsection 7a71
 includ+ "o or m su* memb]s f ea* ( !   
foll[+ categories3  7,a7 ,cl9ical       
endocr9ologi/s4  7,b7 ,physician        
specialties 7o!r ?an z describ$ 9       
subp>agraph 7,a77 t play a role 9       
diseases & complications describ$ 9     
subsection 7a71 su* z c>diologi/s1      
nephrologi/s1 & eye c>e pr(essionals4   
7,c7 ,prim>y c>e physicians4  7,d7      
,non-physician heal? c>e pr(essionals1  
su* z c]tifi$ diabetes educators1       
regi/]$ dieticians & nutrition          
pr(essionals1 nurses1 nurse             
practition]s1 & physician assi/ants4    
7,e7 ,pati5t advocates4  7,f7 ,national 
exp]ts 9 ! duties li/$ "u subsection    
7c74  7,g7 ,heal? c>e provid]s furni%+  
s]vices to a pati5t population t consi/s

 ( a high p]c5tage 7z specifi$ by !     
,secret>y7 ( individuals :o are enroll$ 
9 a ,/ate plan "u title ,,xix ( !       
,social ,security ,act or :o are n cov]$
 "u a heal? plan or heal? insurance     
cov]age4  7#c7 ,*airp]son ,! vot+ memb]s
 ( ! ,commission %all select a *airp]son
 f ! memb]s appo9t$ "u p>agraph 7#b7 f !
 category "u p>agraph 7#b77;,a74  7#d7  
,meet+s ,! ,commission %all meet at lea/
 twice1 & n m ?an #d times1 a ye>4  7#e7
 ,bo>d t]ms ,memb]s ( ! ,commission     
appo9t$ pursuant to subp>agraph 7,b7 or 
7,c7 ( p>agraph 7#a71 includ+ !         
*airp]son1 %all s]ve = a #c-ye> t]m4 ,a 
vacancy on ! ,commission %all be fill$ 9
 ! same mann] z ! orig9al appo9tm5ts4   
7c7 ,duties ,! ,commission %all-- 7#a7  
evaluate programs ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices reg>d+ ! utilization 
( diabetes scre5+ b5efits1 annual       
wellness visits1 & o!r prev5tive heal?  
b5efits t may r$uce ! incid5ce ( !      
diseases & complications describ$ 9     
subsection 7a71 includ+ expla9+ problems

 reg>d+ su* utilization & relat$ data   
collection me*anisms2  7#b7 id5tify     
curr5t activities & critical gaps 9     
,f$]al ef=ts to support cl9icians 9     
provid+ integrat$1 high-quality c>e to  
individuals ) any ( ! diseases &        
complications describ$ 9 subsection 7a72
  7#c7 make recomm5dations reg>d+ !     
coord9ation ( cl9ically-bas$ activities 
t are be+ support$ by ! ,f$]al ,gov]nm5t
 ) respect to ! diseases & complications
 describ$ 9 subsection 7a72  7#d7 make  
recomm5dations reg>d+ ! developm5t &    
coord9ation ( f$]ally fund$ cl9ical     
practice support tools = physicians &   
o!r heal? c>e pr(essionals 9 c>+ = &    
manag+ ! c>e ( individuals ) any ( !    
diseases & complications describ$ 9     
subsection 7a71 specifically ) reg>d to 
implem5tation ( new treatm5ts &         
te*nologies2  7#e7 evaluate programs    
describ$ 9 subsection 7a7 t are 9       
exi/5ce z ( ! date ( ! enactm5t ( ?is   
section & det]m9e if su* programs are   
meet+ ! ne$s id5tifi$ 9 p>agraph 7#b7 &1

 if su* programs are det]m9$ z n meet+  
su* ne$s1 recomm5d programs t w\ld be m 
appropriate2  7#f7 recomm5d1 ) respect  
to ! diseases & complications describ$ 9
 subsection 7a71 cl9ical pa?ways = new  
te*nologies & treatm5ts1 includ+ future 
data collection activities1 t may be    
develop$ & !n us$ to evaluate-- 7,a7    
v>i\s c>e models & me?ods2 &  7,b7 !    
impact ( su* models & me?ods on quality 
( c>e z measur$ by appropriate c>e      
p>amet]s 7su* z ,a#a;,c1 blood pressure1
 & *ole/]ol levels72  7#g7 evaluate &   
exp& education & aw>5ess activities     
provid$ to physicians & o!r heal? c>e   
pr(essionals reg>d+ cl9ical practices = 
! prev5tion ( ! diseases & complications
 describ$ 9 subsection 7a72  7#h7 review
 & recomm5d appropriate me?ods = outrea*
 & dissem9ation ( educational res\rces  
t-- 7,a7 reg>d ! diseases &             
complications describ$ 9 subsection 7a72
  7,b7 are fund$ by ! ,f$]al ,gov]nm5t2 
&  7,c7 are int5d$ = heal? c>e          
pr(essionals & ! public2 &  7#i7 c>ry   

out o!r activities1 su* z activities    
relat+ to ! areas ( public heal? &      
nutrition1 t ! ,commission deems        
appropriate ) respect to ! diseases &   
complications describ$ 9 subsection 7a74
  7d7 ,op]at+ plan  7#a7 ,initial plan  
,n lat] ?an #ij days aft] its fir/      
meet+1 ! ,commission %all submit to !   
,secret>y & ! ,congress an op]at+ plan =
 c>ry+ out ! activities ( ! ,commission 
z describ$ 9 subsection 7c74 ,su* op]at+
 plan may include--  7,a7 a li/ (       
specific activities t ! ,commission     
plans to conduct = purposes ( c>ry+ out 
! duties describ$ 9 ea* ( ! p>agraphs 9 
subsection 7c72  7,b7 a plan = complet+ 
! activities2  7,c7 a li/ ( memb]s ( !  
,commission & o!r individuals :o are n  
memb]s ( ! ,commission :o w ne$ to be   
involv$ to conduct su* activities2  7,d7
 an explanation ( ,f$]al ag5cy          
involvem5t & coord9ation ne$$ to conduct
 su* activities2  7,e7 a budget =       
conduct+ su* activities2  7,f7 a plan = 
evaluat+ ! value & pot5tial impact ( !  

,commission's "w & recomm5dations1      
includ+ ! possible cont9uation ( !      
,commission = ! purposes ( ov]see+ _!   
implem5tation2 &  7,g7 o!r in=mation t !
 ,commission deems appropriate4  7#b7   
,updates ,! ,commission %all p]iodically
 update ! op]at+ plan "u p>agraph 7#a7 &
 submit su* updates to ! ,secret>y & !  
,congress4  7e7 ,f9al report ,by n lat] 
?an #c ye>s aft] ! date ( !             
,commission's fir/ meet+1 ! ,commission 
%all submit to ! ,secret>y & ! ,congress
 a f9al report conta9+ all ( ! f9d+s &  
recomm5dations requir$ by ?is section4  
,n lat] ?an #abj days aft] ! submission 
( ! f9al report1 ! ,secret>y %all review
 ! plan requir$ by subsection           
7d77#a77;,f7 & submit to ! ,congress a  
recomm5dation on :e!r ! ,commission %\ld
 be reau?oriz$ to op]ate aft] fiscal ye>
 #bjai4  7f7 ,sunset ,! ,commission %all
 t]m9ate at ! end ( fiscal ye> #bjai4  4
  ,am5d ! title s z to read3 ,a bill to 
am5d ! ,public ,heal? ,s]vice ,act to   
fo/] m effective implem5tation &        

coord9ation ( cl9ical c>e = p ) a       
complex metabolic or autoimmune disease1
 a disease result+ f insul9 defici5cy or
 insul9 resi/ance1 or complications     
caus$ by su* a disease1 & = o!r         
purposes44  ,novemb] #ad1 #bjaf ,report$
 ) am5dm5ts1 committ$ to ! ,committee ( 
! ,:ole ,h\se on ! ,/ate ( ! ,union1 &  
ord]$ to be pr9t$