Ill STAT. 366 PUBLIC LAW 105-33—AUG. 5, 1997 described in subparagraphs (B), (C), and (D) of section 1861(pp)(l))," before "(3)". 42 USC 1395Z (e) EFFECTIVE DATE. —The amendments made by this section i^ote. shall apply to items and services furnished on or after January 1, 1998. 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)(l) The term 'diabetes outpatient self-management training services' megms 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
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