,,ii #aaith ,,congress #ast ,session ,s4 #aibe ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #b1 #bjbe ,mrs4 ,shaheen 7for herself and ,ms4 ,collins7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to improve access to diabetes outpatient self-management training services1 to require the ,center for ,medicare and ,medicaid ,innovation to test the provision of virtual 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 #bjbe4 #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 and 7,b7 by striking the physician who is managing the individual's diabetic condition and inserting a physician or qualified nonphysician practitioner2 7#b7 in paragraph 7#b77;,b71 by striking paragraph and inserting subparagraph2 and 7#c7 by adding at the end the following new paragraph3 7#c77;,a7 ,for purposes of paragraph 7#a7 and subject to subparagraph 7,b71 the times specified in this paragraph are the following3 7i7 ,an initial #aj hours of individual or group educational and training services to remain available until used4 7ii7 ,an additional #b hours of individual or group educational and training services each year1 beginning with the year in which the initial #aj hours described in subparagraph 7,a7 are completed4 7,b7 ,the ,secretary shall not limit the quantity or duration of educational and training services furnished by a certified provider to an individual with diabetes if such services are deemed medically necessary by a physician or qualified non-physician practitioner4 4 7b7 ,medical nutrition therapy services ,section #ahfa7s77#b77,v7 of the ,social ,security ,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 the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is amended-- 7#a7 in subsection 7a77#a7-- 7,a7 by striking and 7,,hh7 and inserting 7,,hh72 and 7,b7 by inserting the following before the semicolon at the end3 and 7,,ii7 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 7b71 in the first sentence-- 7,a7 by striking 1 and 7#ac7 and inserting 7#ac72 and 7,b7 by striking #ahfa7n744and inserting #ahfa7n71 and 7#ad7 such deductible shall not apply with respect to diabetes outpatient self-management training services 7as defined in section #ahfa7qq774 7d7 ,application ,the amendments made by this section shall apply with respect to items and services furnished on or after ,january #a1 #bjbg4 #c4 ,,cmi testing of providing virtual diabetes outpatient self-management training services ,section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 is amended-- 7#a7 in subsection 7b77#b77;,a71 by adding at the end the following new sentence3 8,the models selected under this subparagraph shall include the testing of the model described in subsection 7h7402 and 7#b7 by adding at the end the following new subsection3 7h7 ,testing of providing virtual diabetes outpatient self-,management training services 7#a7 ,establishment ,not later than ,january #a1 #bjbf1 the ,secretary shall implement a model to test the impact of providing coverage under title ,,xviii for virtual diabetes outpatient self-management training services furnished to applicable beneficiaries with respect to improved health outcomes for such applicable beneficiaries and reduced expenditures under such title ,,xviii4 7#b7 ,model design 7,a7 ,in general ,the ,secretary shall design the model under this subsection in such a manner to allow for the evaluation of demographic characteristics of applicable beneficiaries participating in such model and the extent to which such model accomplishes the following purposes3 7i7 ,improvement in health outcomes with respect to the diabetic conditions1 including by reducing ,a#a;c levels4 7ii7 ,reduced hospitalizations due to diabetic-related complications4 7iii7 ,increased utilization of diabetes outpatient self-management training services as evidenced by1 for example1 ,medicare beneficiary participation and utilization of covered hours during the first year and subsequent years or use of diabetes outpatient self-management training services in rural and underserved communities4 7iv7 ,improved medication adherence4 7v7 ,reduced expenditures under this title attributable to the model4 7,b7 ,consultation ,in designing the model under this subsection1 the ,secretary shall1 not later than #c months after the date of the enactment of this subsection1 consult with stakeholders in the field of diabetes care and education1 clinicians in the primary care community1 experts in digital health1 and beneficiary groups4 7#c7 ,definitions ,in this subsection3 7,a7 ,applicable beneficiary ,the term applicable beneficiary means an individual with diabetes as described in section #ahfa7qq74 7,b7 ,qualified web-based program ,the term qualified web-based program means a web-based program-- 7i7 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 7ii7 that meets the quality standards described in section #ahfa7qq77#b77;,b74 7,c7 ,virtual diabetes outpatient self-management training services ,the term virtual diabetes outpatient self-management training services means any diabetes outpatient self-management training services 7as defined in section #ahfa7qq77 furnished by a qualified web-based program for synchronous or asynchronous diabetes outpatient self-management training services4 4