I
110th CONGRESS
1st Session
H. R. 3544
IN THE HOUSE OF REPRESENTATIVES
September 17, 2007
Mr. Space (for himself, Ms. DeGette, Mr. Gene Green of Texas, Mr. Castle, Mr. Cohen, and Mr. Honda) introduced the following bill; which was referred to the Committee on Energy and Commerce
A BILL
To catalyze change in the care and treatment of diabetes in the United States.
Short title; table of contents; findings
Short title
This Act may be cited
as the Catalyst to Better Diabetes
Care Act of 2007
.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents; findings.
Sec. 2. Medicare diabetes screening collaboration and outreach program.
Sec. 3. Advisory group regarding diabetes and chronic illness employee wellness incentivization and disease management best practices.
Sec. 4. National Diabetes Report Card.
Sec. 5. Improvement of vital statistics collection.
Sec. 6. Study on appropriate level of diabetes medical education.
Findings
The Congress finds as follows:
Diabetes is a chronic public health problem in the United States that is getting worse.
According to the Centers for Disease Control and Prevention:
One in three Americans born in 2000 will get diabetes.
One in two Hispanic females born in 2000 will get diabetes.
1,500,000 new cases of diabetes were diagnosed in adults in 2005.
In 2005, 20,800,000 Americans had diabetes, which is 7 percent of the population of the United States.
6,200,000 Americans are currently undiagnosed.
About one in every 500 children and adolescents have type 1 diabetes.
African-Americans are nearly twice as likely as whites to have diabetes.
Nearly 13 percent of American Indians and Alaska Natives over 20 years old have diagnosed diabetes.
In States with significant Asian populations, Asians were 1.5 to 2 times as likely as whites to have diagnosed diabetes.
Diabetes carries staggering costs:
In 2002, the total amount of the direct and indirect costs of diabetes was estimated at $132,000,000,000 according to the American Diabetes Association.
18 percent of the Medicare population has diabetes but spending on this group of people consumes 32 percent of the Medicare budget according to the Center for Medicare & Medicaid Services.
Diabetes is deadly. According to the Centers for Disease Control and Prevention:
In 2002, according to death certificate reports, diabetes contributed to an official number of 224,092 deaths.
Diabetes is likely to be seriously underreported as studies have found that only 35 percent to 40 percent of decedents with diabetes had it listed anywhere on the death certificate and only about 10 percent to 15 percent had it listed as the underlying cause of death.
Diabetes complications carry staggering economic and human costs for our country and health system:
According to death certificate reports, diabetes contributes to over 224,000 deaths a year, although this number is likely vastly underreported.
The risk for stroke is 2 to 4 times higher among people with diabetes.
Diabetes is the leading cause of new blindness in America, causing approximately 18,000 new cases of blindness each year.
Diabetes is the leading cause of kidney failure in America, accounting for 44 percent of new cases in 2002.
In 2002, 44,400 Americans with diabetes began treatment for end-stage kidney disease and a total of 153,730 were living on chronic dialysis or with a kidney transplant as a result of their diabetes.
In 2002, approximately 82,000 amputations were performed on Americans with diabetes.
Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5 percent to 10 percent of pregnancies and spontaneous abortions in 15 percent to 20 percent of pregnancies.
Diabetes is unique because many of its complications and tremendous costs are largely preventable through early detection, better education on diabetes self-management, and improved delivery of available medical treatment:
According to the Agency for Healthcare Research and Quality, appropriate primary care for diabetes complications could have saved the Medicare and Medicaid programs $2,500,000,000 in hospital costs in 2001 alone.
According to the Diabetes Prevention Project sponsored by the National Institutes of Health, lifestyle interventions such as diet and moderate physical activity for those with prediabetes reduced the development of diabetes by 58 percent; among Americans aged 60 and over, lifestyle interventions reduced diabetes by 71 percent.
Research shows detecting and treating diabetic eye disease can reduce the development of severe vision loss by 50 percent to 60 percent.
Research shows comprehensive foot care programs can reduce amputation rates by 45 percent to 85 percent.
Research shows detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30 percent to 70 percent.
Medicare diabetes screening collaboration and outreach program
Establishment
With
respect to diabetes screening tests provided for under the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law
108–173) and for the purposes of reducing the number of undiagnosed
beneficiaries with diabetes or prediabetes in the Medicare program, the
Secretary of Health and Human Services (in this section referred to as the
Secretary
), in collaboration with the Director of the Centers
for Disease Control and Prevention (in this section referred to as the
Director
), shall—
review uptake and utilization of the diabetes screening benefit to identify and address any existing problems with regard to utilization and data collection mechanisms to accurately track uptake;
establish an outreach program to identify existing efforts by agencies and by the private and nonprofit sectors to increase awareness among Medicare beneficiaries and providers of the diabetes screening benefit; and
maximize economies of scale, cost effectiveness, and resource allocation in increasing utilization of the diabetes screening benefit.
Consultation
In carrying out this section, the Secretary and the Director shall consult with—
various units of the Federal Government, including the Centers for Medicare & Medicaid Services, the Surgeon General of the Public Health Service, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, and the National Institutes of Health; and
entities with an interest in diabetes, including industry, voluntary health organizations, trade associations, and professional societies.
Advisory group regarding diabetes and chronic illness employee wellness incentivization and disease management best practices
Establishment
The Secretary of Commerce shall establish an advisory group consisting of representatives of the public and private sector. The advisory group shall include representatives from the Department of Commerce, the Department of Health and Human Services, the Small Business Administration, and public and private sector entities with experience in administering and operating employee wellness and disease management programs.
Duties
The advisory group established under subsection (a) shall examine and make recommendations of best practices of chronic illness employee wellness incentivization and disease management programs in order to—
provide public and private sector entities with improved information in assessing the role of employee wellness incentivization and disease management programs in saving money and improving quality of life for patients with chronic illnesses; and
encourage the adoption of effective chronic illness employee wellness and disease management programs.
Report
Not later than 1 year after the date of the enactment of this Act, the advisory group established under subsection (a) shall submit to the Secretary of Health and Human Services, the Speaker and Minority Leader of the House of Representatives, and the Majority Leader and Minority Leader of the Senate, the results of the examination under subsection (b)(1).
National Diabetes Report Card
In general
The Secretary of
Health and Human Services (referred to in this section as the
Secretary
), in collaboration with the Director of the Centers
for Disease Control and Prevention (referred to in this section as the
Director
), shall prepare on a biennial basis a national diabetes
report card (referred to in this section as a Report Card
) for
the Nation and, to the extent possible, for each State.
Contents
In general
Each Report Card shall include statistically valid aggregate health outcomes related to individuals diagnosed with diabetes and prediabetes including—
preventative care practices and quality of care;
risk factors; and
outcomes.
Updated reports
Each Report Card that is prepared after the initial Report Card shall include trend analysis for the Nation and, to the extent possible, for each State, for the purpose of—
tracking progress in meeting established national goals and objectives for improving diabetes care, costs, and prevalence (including Healthy People 2010); and
informing policy and program development.
Availability
The Secretary, in collaboration with the Director, shall make each Report Card publicly available, including by posting the Report Card on the Internet.
Improvement of vital statistics collection
In general
The Secretary of Health and Human Services (referred to
in this section as the Secretary
), acting through the Director
of the Centers for Disease Control and Prevention and in collaboration with
appropriate agencies and States, shall—
promote the education and training of physicians on the importance of birth and death certificate data and how to properly complete these documents, including the collection of such data for diabetes and other chronic diseases;
encourage State adoption of the latest standard revisions of birth and death certificates; and
work with States to re-engineer their vital statistics systems in order to provide cost-effective, timely, and accurate vital systems data.
Death certificate additional language
In carrying out this section, the Secretary may promote the addition of language to death certificates to improve collection of diabetes mortality data, including the addition of a question for the individual certifying to the cause of death regarding whether the deceased had diabetes.
Study on appropriate level of diabetes medical education
In general
The Secretary of
Health and Human Services (in this section referred to as the
Secretary
) shall, in collaboration with the Institute of
Medicine and appropriate associations and councils, conduct a study of the
impact of diabetes on the practice of medicine in the United States and the
appropriateness of the level of diabetes medical education that should be
required prior to licensure, board certification, and board
recertification.
Report
Not later than 2 years after the date of the enactment of this Act, the Secretary shall submit a report on the study under subsection (a) to the Committees on Ways and Means and Energy and Commerce of the House of Representatives and the Committees on Finance and Health, Education, Labor, and Pensions of the Senate.