DIABETES SELF-MANAGEMENT BENEFITS.

SEC. 4105. DIABETES SELF-MANAGEMENT BENEFITS. (a) Coverage of Diabetes Outpatient Self-Management Training Services.— (1) In general.—Section 1861 (42 U.S.C. 1395x), as amended by sections 4103(a) and 4104(a), is amended— (A) in subsection (s)(2)— (i) by striking “and” at the end of subparagraph (Q); (ii) by adding “and” at the end of subparagraph (R); and (iii) by adding at the end the following new subparagraph: “(S) diabetes outpatient self-management training services (as defined in subsection (qq)); and”; and (B) by adding at the end the following new subsection: “Diabetes Outpatient Self-Management Training Services “(qq)(1) The term ‘diabetes outpatient self-management training services’ means educational and training services furnished (at such times as the Secretary determines appropriate) to an individual with diabetes by a certified provider (as described in paragraph (2)(A)) in an outpatient setting by an individual or entity who meets the quality standards described in paragraph (2)(B), but only if the physician who is managing the individual’s diabetic condition certifies that such services are needed under a comprehensive plan of care related to the individual’s diabetic condition to ensure therapy compliance or to provide the individual with necessary skills and knowledge (including skills related to the self-administration of injectable drugs) to participate in the management of the individual’s condition. “(2) In paragraph (1)— “(A) a ‘certified provider’ is a physician, or other individual or entity designated by the Secretary, that, in addition to providing diabetes outpatient self-management training services, provides other items or services for which payment may be made under this title; and “(B) a physician, or such other individual or entity, meets the quality standards described in this paragraph if the physician, or individual or entity, meets quality standards established by the Secretary, except that the physician or other individual or entity shall be deemed to have met such standards if the physician or other individual or entity meets applicable standards originally established by the National Diabetes Advisory Board and subsequently revised by organizations who participated in the establishment of standards by such Board, or is recognized by an organization that represents individuals (including individuals under this title) with diabetes as meeting standards for furnishing the services.”. (2) Payment under physician fee schedule.—Section 1848(j)(3) (42 U.S.C. 1395w–4(j)(3)) as amended in sections 111 STAT. 3674102, 4103, and 4104, is amended by inserting “(2)(S),” before “(3),”. (3) Consultation with organizations in establishing payment amounts for services provided by physicians.—In establishing payment amounts under section 1848 of the Social Security Act for physicians’ services consisting of diabetes outpatient self-management training services, the Secretary of Health and Human Services shall consult with appropriate organizations, including such organizations representing individuals or medicare beneficiaries with diabetes. (b) Blood-Testing Strips for Individuals With Diabetes.— (1) Including strips and monitors as durable medical equipment.—The first sentence of section 1861(n) (42 U.S.C. 1395x(n)) is amended by inserting before the semicolon the following: “, and includes blood-testing strips and blood glucose monitors for individuals with diabetes without regard to whether the individual has Type I or Type II diabetes or to the individual’s use of insulin (as determined under standards established by the Secretary in consultation with the appropriate organizations)”. (2) 10 percent reduction in payments for testing strips.—Section 1834(a)(2)(B)(iv) (42 U.S.C. 1395m(a)(2)(B)(iv)) is amended by adding before the period the following: “(reduced by 10 percent, in the case of a blood glucose testing strip furnished after 1997 for an individual with diabetes)”. (c) Establishment of Outcome Measures for Beneficiaries With Diabetes.— (1) In general.—The Secretary of Health and Human Services, in consultation with appropriate organizations, shall establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for purposes of evaluating the improvement of the health status of medicare beneficiaries with diabetes mellitus. (2) Recommendations for modifications to screening benefits.—Taking into account information on the health status of medicare beneficiaries with diabetes mellitus as measured under the outcome measures established under paragraph (1), the Secretary shall from time to time submit recommendations to Congress regarding modifications to the coverage of services for such beneficiaries under the medicare program. (d) Effective Date.— (1) In general.—Except as provided in paragraph (2), the amendments made by this section shall apply to items and services furnished on or after July 1, 1998. (2) Testing strips.—The amendment made by subsection (b)(2) shall apply with respect to blood glucose testing strips furnished on or after January 1, 1998.