,i #aafth ,,congress #ast ,session ,h4 ,r4 #ahdj ,,in ,,the ,,house ,,of ,,representatives ,march #ba1 #bjai,mr4 ,reed 7for himself1 ,ms4 ,de,gette1 ,mr4 ,ruiz1 ,ms4 ,del,bene1 ,mrs4 ,brooks of ,indiana1 and ,mr4 ,kelly of ,pennsylvania7 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 improve access to diabetes outpatient self-management training services1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,expanding ,access to ,diabetes ,self-,management ,training ,act of #bjai or the ,expanding ,access to ,,dsmt ,act of #bjai4 #b4 ,improving access to diabetes outpatient self-management training services 7a7 ,in general ,section #ahfa7qq7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7qq77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 by striking the ,secretary determines appropriate and inserting specified in paragraph 7#c72 7,b7 by inserting or qualified nonphysician practitioner after only if the physician2 and 7,c7 by inserting 7or other physician or qualified nonphysician practitioner furnishing items or services to such individual1 in coordination with the physician or qualified nonphysician practitioner managing such individual's diabetic condition7 after managing the individual's diabetic condition2 7#b7 in paragraph 7#b77;,b71 by striking paragraph and inserting subparagraph2 and 7#c7 by adding at the end the following new paragraphs3 7#c7 ,for purposes of paragraph 7#a71 the times specified in this paragraph are the following3 7,a7 ,an initial #aj hours of educational and training services described in paragraph 7#a71 to remain available until used4 7,b7 ,six additional hours 7or a greater number of hours if determined appropriate by the ,secretary7 of such services during the year in which the individual exhausts the initial hours described in subparagraph 7,a71 provided that the physician or qualified nonphysician practitioner who is managing the individual's diabetic condition 7or other physician or qualified nonphysician practitioner furnishing items or services to such individual1 in coordination with the physician or qualified nonphysician practitioner managing such individual's diabetic condition7 certifies the medical necessity of such additional hours4 7,c7 ,six additional hours 7or a greater number of hours if determined appropriate by the ,secretary7 of such services per year for each year beginning after the year in which the individual exhausts the initial hours described in subparagraph 7,a71 provided that the physician or qualified nonphysician practitioner who is managing the individual's diabetic condition 7or other physician or qualified nonphysician practitioner furnishing items or services to such individual1 in coordination with the physician or qualified nonphysician practitioner managing such individual's diabetic condition7 certifies the medical necessity of such additional hours4 7,d7 ,for a year in which the individual has received additional hours described in subparagraph 7,b7 or 7,c7 and exhausted such hours1 an additional number of hours determined appropriate by the physician or qualified nonphysician practitioner who is managing the individual's diabetic condition 7or other physician or qualified nonphysician practitioner furnishing items or services to such individual1 in coordination with the physician or qualified nonphysician practitioner managing such individual's diabetic condition71 provided that the physician or qualified nonphysician practitioner who is managing the individual's diabetic condition 7or other physician or qualified nonphysician practitioner furnishing items or services to such individual1 in coordination with the physician or qualified nonphysician practitioner managing such individual's diabetic condition7 certifies that-- 7i7 there has been a change in the individual's diagnosis1 medical condition1 or treatment regimen2 7ii7 the individual is not meeting appropriate clinical outcomes 7as determined by such physician or qualified nonphysician practitioner7 for such condition2 or 7iii7 the individual meets other criteria that necessitates such additional number of hours1 as determined by the ,secretary4 7#d7 ,for purposes of this section1 the term qualified nonphysician practitioner means a physician assistant1 nurse practitioner1 or clinical nurse specialist 7as defined in section #ahfa7;aa77#e774 4 7b7 ,medical nutrition therapy services ,section #ahfa7s77#b77,v7 of such ,act 7#db ,u4,s4,c4 #aciex7s77#b77,v77 is amended-- 7#a7 by striking clause 7i72 7#b7 by redesignating clauses 7ii7 and 7iii7 as clauses 7i7 and 7ii71 respectively2 and 7#c7 in clause 7ii71 as so redesignated1 by striking after consideration of and inserting consistent with4 7c7 ,cost-,sharing ,section #ahcc of such ,act 7#db ,u4,s4,c4 #aciel7 is amended-- 7#a7 in subsection 7a77#a7-- 7,a7 by striking and 7,,cc7 and inserting 7,,cc72 and 7,b7 by striking the semicolon at the end and inserting 1 and 7,,dd7 with respect to diabetes outpatient self-management training services 7as defined in section #ahfa7qq771 the amount paid shall be #ajj percent of the lesser of the actual charge for the services or the amount determined under the fee schedule that applies to such services under this part22 and 7#b7 in subsection 7b7-- 7,a7 by striking and 7#aj7 and inserting 7#aj72 and 7,b7 by striking #ahfa7;hhh77#a774 and inserting #ahfa7;hhh77#a771 and 7#aa7 such deductible shall not apply with respect to diabetes outpatient self-management training services 7as defined in section #ahfa7qq774 7d7 ,revision of manual ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall revise the ,medicare ,benefit ,policy ,manual to ensure that diabetes outpatient self-management training services 7as defined in section #ahfa7qq7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7qq771 as amended by subsection 7a77 may be furnished by an entity that is a hospital outpatient department at alternate1 nonhospital sites 7including community-based locations74 7e7 ,application ,the amendments made by this section shall apply with respect to items and services furnished on or after ,january #a1 #bjbj4 #c4 ,virtual ,diabetes ,outpatient ,self-,management ,training ,services ,demonstration ,program 7a7 ,in general ,beginning not later than ,january #a1 #bjbj1 the ,secretary of ,health and ,human ,services 7in this section referred to as the 8,secretary07 shall select an appropriate number of applicable beneficiaries to participate in a #b-year demonstration program to test the impact of furnishing diabetes outpatient self-management training services through a qualified online platform with respect to cost and clinical outcomes for such applicable beneficiaries4 ,under such program1 diabetes outpatient self-management training services furnished through a qualified online platform to an applicable beneficiary shall be covered under title ,,xviii of the ,social ,security ,act1 and payment for such services shall be made in the same manner as payment is made under such title for such services furnished in an outpatient setting4 7b7 ,definitions ,in this section3 7#a7 ,applicable beneficiary ,the term applicable beneficiary means an individual-- 7,a7 who is enrolled under part ,b of title ,,xviii of the ,social ,security ,act2 7,b7 who has a diagnosis of diabetes2 and 7,c7 who agrees to take part in the demonstration program described in subsection 7a74 7#b7 ,qualified online platform ,the term qualified online platform means an online-based platform-- 7,a7 designed to furnish educational and training services to an individual with diabetes to ensure therapy compliance with respect to the individual's diabetic condition or to provide the individual with necessary skills and knowledge 7including skills related to the self-administration of injectable drugs7 to participate in the individual's management of such condition2 and 7,b7 that meets the ,national ,standards for ,diabetes ,self-,management ,education and ,support1 as jointly published by the ,american ,association of ,diabetes ,educators and the ,american ,diabetes ,association4 7#c7 ,diabetes self-management training services ,the term diabetes outpatient self-management training services has the meaning given such term in section #ahfa7qq7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7qq77 except that the requirement in paragraph 7#a7 of such section with respect to such services being furnished in an outpatient setting shall not apply4 7c7 ,evaluation ,the ,secretary shall evaluate the demonstration program described in subsection 7a7 based on the following criteria3 7#a7 ,the improvement1 if any1 in health outcomes with respect to the diabetic conditions of applicable beneficiaries participating in such program as evidenced by-- 7,a7 any improvement attributable to such program in the knowledge of such beneficiaries with respect to such conditions2 7,b7 any behavioral changes attributable to such program2 7,c7 any clinical outcome improvements attributable to such program2 7,d7 any quality of life improvements attributable to such program2 and 7,e7 the overall satisfaction of such beneficiaries with such program4 7#b7 ,reductions1 if any1 in expenditures under title ,,xviii of the ,social ,security ,act attributable to such program4 7#c7 ,other criteria determined appropriate by the ,secretary4 7d7 ,report ,not later than #ah months after the date of the completion of the demonstration program described in subsection 7a71 the ,secretary shall submit to ,congress a report containing-- 7#a7 the results of the evaluation described in subsection 7c72 7#b7 an analysis of the demographic characteristics of applicable beneficiaries who participated in such program2 and 7#c7 a recommendation on whether such program should be continued or expanded4 7e7 ,waiver authority ,the ,secretary may waive such requirements of titles ,,xi and ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq41 #acie et seq47 as may be necessary to carry out the provisions of this section4 7f7 ,authority ,to expand demonstration program ,notwithstanding subsection 7a71 taking into account the evaluation described in subsection 7c71 the ,secretary may1 through rulemaking1 expand the duration and the scope of the demonstration program described in subsection 7a71 to the extent determined appropriate by the ,secretary1 if-- 7#a7 the ,secretary determines that such expansion is expected to-- 7,a7 reduce spending under title ,,xviii of the ,social ,security ,act without reducing quality of care2 or 7,b7 improve the quality of care for individuals enrolled under part ,b of such title without increasing spending under such title2 7#b7 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that such expansion would reduce 7or would not result in any increase in7 net program spending under such title2 and 7#c7 the ,secretary determines that such expansion would not deny or limit the coverage or provision of benefits under such title for individuals enrolled under part ,b of such title4