,,ii #aaf? ,,congress #a/ ,session ,s4 #had ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,m>* #ad1 #bjai,mrs4 ,%ahe5 7= h]self & ,ms4 ,coll9s7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to improve access to diabetes outpati5t self-managem5t tra9+ s]vices1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,exp&+ ,access to ,diabetes ,self-,managem5t ,tra9+ ,act ( #bjai4 #b4 ,improv+ access to diabetes outpati5t self-managem5t tra9+ s]vices 7a7 ,9 g5]al ,section #ahfa7qq7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7qq77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 by /rik+ ! ,secret>y det]m9es appropriate & ins]t+ specifi$ 9 p>agraph 7#c72 7,b7 by ins]t+ or qualifi$ nonphysician practition] aft] only if ! physician2 & 7,c7 by ins]t+ 7or o!r physician or qualifi$ nonphysician practition] furni%+ items or s]vices to su* individual1 9 coord9ation ) ! physician or qualifi$ nonphysician practition] manag+ su* individual's diabetic condition7 aft] manag+ ! individual's diabetic condition2 7#b7 9 p>agraph 7#b77;,b71 by /rik+ p>agraph & ins]t+ subp>agraph2 & 7#c7 by add+ at ! end ! foll[+ new p>agraphs3 7#c7 ,= purposes ( p>agraph 7#a71 ! times specifi$ 9 ?is p>agraph are ! foll[+3 7,a7 ,an initial #aj h\rs ( educational & tra9+ s]vices describ$ 9 p>agraph 7#a71 to rema9 available until us$4 7,b7 ,six additional h\rs 7or a great] numb] ( h\rs if det]m9$ appropriate by ! ,secret>y7 ( su* s]vices dur+ ! ye> 9 :i* ! individual exhau/s ! initial h\rs describ$ 9 subp>agraph 7,a71 provid$ t ! physician or qualifi$ nonphysician practition] :o is manag+ ! individual's diabetic condition 7or o!r physician or qualifi$ nonphysician practition] furni%+ items or s]vices to su* individual1 9 coord9ation ) ! physician or qualifi$ nonphysician practition] manag+ su* individual's diabetic condition7 c]tifies ! m$ical necessity ( su* additional h\rs4 7,c7 ,six additional h\rs 7or a great] numb] ( h\rs if det]m9$ appropriate by ! ,secret>y7 ( su* s]vices p] ye> = ea* ye> beg9n+ aft] ! ye> 9 :i* ! individual exhau/s ! initial h\rs describ$ 9 subp>agraph 7,a71 provid$ t ! physician or qualifi$ nonphysician practition] :o is manag+ ! individual's diabetic condition 7or o!r physician or qualifi$ nonphysician practition] furni%+ items or s]vices to su* individual1 9 coord9ation ) ! physician or qualifi$ nonphysician practition] manag+ su* individual's diabetic condition7 c]tifies ! m$ical necessity ( su* additional h\rs4 7,d7 ,= a ye> 9 :i* ! individual has receiv$ additional h\rs describ$ 9 subp>agraph 7,b7 or 7,c7 & exhau/$ su* h\rs1 an additional numb] ( h\rs det]m9$ appropriate by ! physician or qualifi$ nonphysician practition] :o is manag+ ! individual's diabetic condition 7or o!r physician or qualifi$ nonphysician practition] furni%+ items or s]vices to su* individual1 9 coord9ation ) ! physician or qualifi$ nonphysician practition] manag+ su* individual's diabetic condition71 provid$ t ! physician or qualifi$ nonphysician practition] :o is manag+ ! individual's diabetic condition 7or o!r physician or qualifi$ nonphysician practition] furni%+ items or s]vices to su* individual1 9 coord9ation ) ! physician or qualifi$ nonphysician practition] manag+ su* individual's diabetic condition7 c]tifies t-- 7i7 !re has be5 a *ange 9 ! individual's diagnosis1 m$ical condition1 or treatm5t regim52 7ii7 ! individual is n meet+ appropriate cl9ical outcomes 7z det]m9$ by su* physician or qualifi$ nonphysician practition]7 = su* condition2 or 7iii7 ! individual meets o!r crit]ia t necessitates su* additional numb] ( h\rs1 z det]m9$ by ! ,secret>y4 7#d7 ,= purposes ( ?is section1 ! t]m qualifi$ nonphysician practition] means a physician assi/ant1 nurse practition]1 or cl9ical nurse speciali/ 7z def9$ 9 section #ahfa7;aa77#e774 4 7b7 ,m$ical nutrition !rapy s]vices ,section #ahfa7s77#b77,v7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77,v77 is am5d$-- 7#a7 by /rik+ clause 7i72 7#b7 by r$esignat+ clauses 7ii7 & 7iii7 z clauses 7i7 & 7ii71 respectively2 & 7#c7 9 clause 7ii71 z s r$esignat$1 by /rik+ aft] consid]ation ( & ins]t+ consi/5t )4 7c7 ,co/-,%>+ ,section #ahcc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is am5d$-- 7#a7 9 subsection 7a77#a7-- 7,a7 by /rik+ & 7,,cc7 & ins]t+ 7,,cc72 & 7,b7 by /rik+ ! semicolon at ! end & ins]t+ 1 & 7,,dd7 ) respect to diabetes outpati5t self-managem5t tra9+ s]vices 7z def9$ 9 section #ahfa7qq771 ! am\nt paid %all be #ajj p]c5t ( ! less] ( ! actual *>ge = ! s]vices or ! am\nt det]m9$ "u ! fee s*$ule t applies to su* s]vices "u ?is "p22 & 7#b7 9 subsection 7b71 9 ! fir/ s5t5ce-- 7,a7 by /rik+ & 7#aj7 & ins]t+ 7#aj72 & 7,b7 by /rik+ #ahfa7;hhh77#a774 & ins]t+ #ahfa7;hhh77#a771 & 7#aa7 su* d$uctible %all n apply ) respect to diabetes outpati5t self-managem5t tra9+ s]vices 7z def9$ 9 section #ahfa7qq774 7d7 ,revision ( manual ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all revise ! ,m$ic>e ,b5efit ,policy ,manual to ensure t diabetes outpati5t self-managem5t tra9+ s]vices 7z def9$ 9 section #ahfa7qq7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7qq771 z am5d$ by subsection 7a77 may be furni%$ by an entity t is a hospital outpati5t dep>tm5t at alt]nate1 nonhospital sites 7includ+ community-bas$ locations74 7e7 ,application ,! am5dm5ts made by ?is section %all apply ) respect to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjbj4 #c4 ,virtual diabetes outpati5t self-managem5t tra9+ s]vices demon/ration program 7a7 ,9 g5]al ,beg9n+ n lat] ?an ,janu>y #a1 #bjbj1 ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! 8,secret>y07 %all select an appropriate numb] ( applicable b5efici>ies to p>ticipate 9 a #b-ye> demon/ration program to te/ ! impact ( furni%+ diabetes outpati5t self-managem5t tra9+ s]vices ?r\gh a qualifi$ onl9e plat=m ) respect to co/ & cl9ical outcomes = su* applicable b5efici>ies4 ,"u su* program1 diabetes outpati5t self-managem5t tra9+ s]vices furni%$ ?r\gh a qualifi$ onl9e plat=m to an applicable b5efici>y %all be cov]$ "u title ,,xviii ( ! ,social ,security ,act1 & paym5t = su* s]vices %all be made 9 ! same mann] z paym5t is made "u su* title = su* s]vices furni%$ 9 an outpati5t sett+4 7b7 ,def9itions ,9 ?is section3 7#a7 ,applicable b5efici>y ,! t]m applicable b5efici>y means an individual-- 7,a7 :o is enroll$ "u "p ,b ( title ,,xviii ( ! ,social ,security ,act2 7,b7 :o has a diagnosis ( diabetes2 & 7,c7 :o agrees to take "p 9 ! demon/ration program describ$ 9 subsection 7a74 7#b7 ,qualifi$ onl9e plat=m ,! t]m qualifi$ onl9e plat=m means an onl9e-bas$ plat=m-- 7,a7 design$ to furni% educational & tra9+ s]vices to an individual ) diabetes to ensure !rapy compliance ) respect to ! individual's diabetic condition or to provide ! individual ) necess>y skills & k 7includ+ skills relat$ to ! self-adm9i/ration ( injectable drugs7 to p>ticipate 9 ! individual's managem5t ( su* condition2 & 7,b7 t meets ! ,national ,/&>ds = ,diabetes ,self-,managem5t ,education & ,support1 z jo9tly publi%$ by ! ,am]ican ,association ( ,diabetes ,educators & ! ,am]ican ,diabetes ,association4 7#c7 ,diabetes self-managem5t tra9+ s]vices ,! t]m diabetes outpati5t self-managem5t tra9+ s]vices has ! mean+ giv5 su* t]m 9 section #ahfa7qq7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7qq77 except t ! requirem5t 9 p>agraph 7#a7 ( su* section ) respect to su* s]vices be+ furni%$ 9 an outpati5t sett+ %all n apply4 7c7 ,evaluation ,! ,secret>y %all evaluate ! demon/ration program describ$ 9 subsection 7a7 bas$ on ! foll[+ crit]ia3 7#a7 ,! improvem5t1 if any1 9 heal? outcomes ) respect to ! diabetic conditions ( applicable b5efici>ies p>ticipat+ 9 su* program z evid5c$ by-- 7,a7 any improvem5t attributable to su* program 9 ! k ( su* b5efici>ies ) respect to su* conditions2 7,b7 any behavioral *anges attributable to su* program2 7,c7 any cl9ical outcome improvem5ts attributable to su* program2 7,d7 any quality ( life improvem5ts attributable to su* program2 & 7,e7 ! ov]all satisfaction ( su* b5efici>ies ) su* program4 7#b7 ,r$uctions1 if any1 9 exp5ditures "u title ,,xviii ( ! ,social ,security ,act attributable to su* program4 7#c7 ,o!r crit]ia det]m9$ appropriate by ! ,secret>y4 7d7 ,report ,n lat] ?an #ah mon?s aft] ! date ( ! completion ( ! demon/ration program describ$ 9 subsection 7a71 ! ,secret>y %all submit to ,congress a report conta9+-- 7#a7 ! results ( ! evaluation describ$ 9 subsection 7c72 7#b7 an analysis ( ! demographic *>act]i/ics ( applicable b5efici>ies :o p>ticipat$ 9 su* program2 & 7#c7 a recomm5dation on :e!r su* program %\ld be cont9u$ or exp&$4 7e7 ,waiv] au?ority ,! ,secret>y may waive su* requirem5ts ( titles ,,xi & ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq41 #acie et seq47 z may be necess>y to c>ry out ! provisions ( ?is section4 7f7 ,au?ority ,to exp& demon/ration program ,not)/&+ subsection 7a71 tak+ into acc\nt ! evaluation describ$ 9 subsection 7c71 ! ,secret>y may1 ?r\gh rulemak+1 exp& ! duration & ! scope ( ! demon/ration program describ$ 9 subsection 7a71 to ! ext5t det]m9$ appropriate by ! ,secret>y1 if-- 7#a7 ! ,secret>y det]m9es t su* expansion is expect$ to-- 7,a7 r$uce sp5d+ "u title ,,xviii ( ! ,social ,security ,act )\t r$uc+ quality ( c>e2 or 7,b7 improve ! quality ( c>e = individuals enroll$ "u "p ,b ( su* title )\t increas+ sp5d+ "u su* title2 7#b7 ! ,*ief ,actu>y ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices c]tifies t su* expansion w\ld r$uce 7or w\ld n result 9 any increase 97 net program sp5d+ "u su* title2 & 7#c7 ! ,secret>y det]m9es t su* expansion w\ld n d5y or limit ! cov]age or provision ( b5efits "u su* title = individuals enroll$ "u "p ,b ( su* title4