AADE e-Advocacy Newsletter

September 2009

Welcome from Kathy Gold, Chair, AADE Advocacy Committee

On behalf of the Advocacy Committee I would like to welcome you to the first edition of e-Advocacy, Advice and Announcements.

If any of you attended the Annual Meeting in DC in 2008, I am that lady who wore the funny Uncle Sam hat. Over the past two years I have become quite attached to that hat and it has become a symbol of our advocacy efforts and have shared it with others who have chosen to become advocates. At the first meeting of the 2009 Advocacy Committee each member was given a hat and instructed to place it in a prominent place that they would see it each morning to remind them to do one thing every day to advocate for our profession of Diabetes Education. Over the past year, we have tried to accomplish that goal and now with the launch of this e-newsletter we hope to share our “hats” with others.

Many of you have been advocates for years, so wearing this hat is nothing new, but I know that this may be brand new for many and like any new hat it needs to be broken in or you won’t wear it. It is our hope that e- Advocacy, Advice and Announcements will provide you with the tools, support, and advice you need to become an advocate extraordinaire!

The definition of an advocate is: one that pleads the cause of another; one that defends or maintains a cause or proposal; or one that supports or promotes the interests of another.

Each and every diabetes educator needs to become an advocate for their cause and right now that is the passage of H.R. 2425. Now this may be an area that many have avoided; many chose not to get involved in political issues; many have never spoken to a legislator, or are in awe of elected officials. After all they are national figures and we are merely diabetes educators.

There are not many Diabetes Educators but we are a mighty group, we fight hard for what is best for our patients, we lobby schools to ensure young children can manage their diabetes in the classroom, we walk miles to support diabetes research. Now it is time to advocate for ourselves. It is our turn to ask others to support our cause.

We hope this newsletter will give you the tools you need to become an effective and motivated advocate. Wear your hat proudly and with enthusiasm!


Kathy Gold, RN MSN CDE, Chair, 2009 AADE Advocacy Committee




The DSMT Act of 2009: Background, Updates and Next Steps!

In 1997 Congress recognized the value of Diabetes Self-Management Training (DSMT) by including it in the Balanced Budget Act (BBA). This provided Medicare coverage for DMST creating a climate that allowed it to be covered by all insurances. In the implementation of this legislation Medicare created language that required individual’s to be a “Medicare provider” in order to bill for services. A variety of groups and individuals qualify for a National Provider Identifier Number (NPI) some of which are hospitals, nursing homes, ambulatory care facilities, durable medical equipment suppliers, clinical laboratories, pharmacies/pharmacists, physicians, dentist, psychologists, nurse practitioners (NPs), and registered dietitians (RDs).

The CDE credential, unfortunately, was not included in the BBA and as a result Certified Diabetes Educators who do not qualify for a NPI (e.g., RNs) cannot bill Medicare for DSMT services.

In 2008 the AADE Board of Directors made it a strategic initative to increase its grassroots efforts. So, on January 6, 2009 (the day the 111th Congress began its first session) AADE and its supporters began a newly charged campaign to advocate for this critical piece of legislation. Since then we have seen a huge increase in the amount letters and phone calls being made to Members of Congress; we have held a national public policy forum; we have taken AADE members to Capitol Hill for visits; we have seen a more engaged advocacy network; we have made contacts in key Congressional districts around the nation and we have seen an increase in chapter, associations and industry support.

However, one of the major hurdles AADE has faced as an advocate group presenting the CDE legislation to Congress was that we kept being asked what the cost was or what is the score of this provision? Not having our bill scored by the Congressional Budget Office (CBO) we could not answer that question other than to say it was budget dust, budget neutral or cost relatively nothing. So, AADE commissioned Dobson DaVanzo & Associates to create a cost estimate of H.R. 2425 over a ten year period from 2011 (the anticipated date the legislation would be implemented) through 2020 using the CBO scoring methodology to help support our cause.

On May 14, 2009 Congresswoman Diana DeGette (D-1st CO) introduced, along with Rep. CASTLE (R-At Large DE), Rep. KIRK (R-10th IL), Rep. BECERRA (D-31st CA), and Rep. SPACE (D-18th OH) HR 2425: The Diabetes Self-Management Act (DSMT) act of 2009.

Since the introduction of H.R. 2425 we have seen 22 new co-sponsors (and anticipate more); we have seen the house include the CDE provision as an amendment in its larger Healthcare Reform bill H.R. 3200 and most recently the Senate Finance Committee released its framework for comprehensive health reform which include the language to designate all CDEs as recognized Medicare providers of DSMT.

Even with all these new milestones that AADE has reached we still have a ways to go before this legislation is passed. We need the language of the CDE provision to be included in the final versions of the Senate and House Healthcare Reform bills; we need AADE members and supporters to continue to actively write letters and call their Members of Congress to communicate the importance of designating all CDEs as Medicare providers of DSMT; we need everyone to tell their friends, families, patients and peers to do the same.

If you would like to take action or become involved you can visit any of the following:

Helen Keller said , "I am only one, but still I am one. I cannot do everything, but still I can do something; and because I cannot do everything I will not refuse to do the something that I can do."


Understanding for US and access for ALL!

Why all Certified Diabetes Educators should be recognized Medicare providers of DSMT.

Over the past 12 years the American Association of Diabetes Educators (AADE) has worked diligently to change the oversight that excluded CDEs as Medicare providers of DSMT and correct the technical language in the regulations.

H.R. 2425, the Medicare DSMT act of 2009, currently has 22 co-sponsors and the language of this bill has also been included in the House Health Care Reform (HCR) bill (H.R. 3200) as an amendment introduced by Rep. Diana DeGette (D-CO 1st). However, we need to increase this number dramatically to guarantee that the language of H.R. 2425 remains in whichever healthcare legislation is passed. And we also need the Senate to include it their HCR bill. We are the closest we have ever been in correcting this oversight but there is still a lot of work to do.

One major obstacle is that the Advocacy Committee has come to realize after many conversations with AADE members that a lot of CDE’s do not understand the need and significance of this legislation.

In an effort to help us all understand what this legislation means to CDEs and those living with, or at risk for, diabetes we have established 8 reasons why all CDE’s should be recognized Medicare providers of Diabetes-Self Management Training:

  1. To ensure that ALL patients have access to the highest quality DSMT.
  2. To increase access of DSMT in rural and under served populations.
  3. To allow ALL CDE’s to be officially recognized as the expert providers of DSMT.
  4. To position ALL CDE’s within current programs, and those working independently, to think and work out of the box in order to expand services to the locations where they may best serve the public.
  5. To attract other health care professionals to the practice of diabetes education.
  6. To position DMST as having significant importance with employers, independent physician practices, hospitals, and insurance companies.
  7. To position CDE’s to negotiate for appropriate reimbursement for the services we provide.
  8. Because we are darn good at what we do, and we are the professionals who are credentialed and qualified to provide DSMT.

These reasons are not talking points to the legislators but created to help you understand the importance of this bill and serve as a catalyst for action! We need you all to write your legislators, attend town hall meetings, and share your stories with your Congressmen and Senators. Let your voices be heard; only we can affect this change-no one else is going to lobby on our behalf.

With scores of CDE’s finding that their programs are closing or downsizing and large and small programs alike being affected and reimbursement being poor as well as our expenses frequently not covered. Now is the time, for the survival of our profession, that we ALL become advocates.

Margaret Mead said it best, “Never doubt that a small group of thoughtful, committed citizens can change the world: indeed, it’s the only thing that ever has.”

For more information on how to contact your legislators log into the AADE Advocacy Action Center.

If you have questions or need any assistance please contact: Martha L. Rinker, Chief Advocacy Officer orJames E. Specker, Advocacy Specialist.

Lastly, please sign the e-petition and forward the petition to groups that you work with and ask for their support of our legislation.

If you would like a hard copy of the petition for your office for patients and peers to sign please click here. Please return hard copies to advocacy@aadenet.org


The 2009 AADE Advocacy Committee

Kathleen Gold, RN MSN CDE, Chair

Sharon Goodsell, RN MED CDE


Jan Pearson, BAN RN CDE

Valerie Quinn, RN BS CDE

Patricia Stuart, BS MPH MS CDE

Georgeanna Turner, BS RN CDE

What's your story?

In an effort to increase our grassroots initiative at the state and federal levels, AADE Advocacy has created this newsletter to keep you informed of legislative issues that affect the profession of diabetes education and diabetes educators.

Grassroots activism consists of a group of like-minded people coming together for a cause they believe in. And what we need is for you to let us know what issues and causes are affecting your community, your state and your profession so we can share that and this group of like-minded people can come together to make a difference.

If you have an issue that is a concern to your community, state and profession that you would like to share you can email AADE at advocacy@aadenet.org

Safer Needle Disposal Options through Legislative Efforts

There exists in the United States a critical public health problem: limited options available for the safe disposal of used needles and other sharps in the community at large. Safe disposal of these needles will protect workers and the public from unnecessary injury and possible infectious disease transmission. In efforts to educate the public about this issue and effective alternative solutions to discarding used sharps into the solid waste system, a coalition of concerned organizations including businesses (i.e. WM, BD, Can-Am Care), associations (i.e., AADE, AMA, APhA), and government agencies was formed, called the Coalition for Safe Community Needle Disposal.

Because options for safe syringe and needle disposal in the community are often limited or poorly understood, it is the goal of this Coalition to:

  1. Educate, inform and advocate for changes among state and federal leaders for safer needle disposal practices which will ultimately remove needles from the solid waste stream, protecting workers and the public from potential needle stick injuries.
  2. Inform, educate, and change the way individuals dispose of used needles by developing and implementing safe, affordable and convenient disposal solutions.
Federal Legislation

On June 19, 2009, Senator Johnny Isakson (R-GA) and Representative Mike Castle (R-DE) introduced S. 1312 and H.R. 2976, respectively. The bills are Federal Medicare Part D Bills that will provide coverage for sharps containers, home needle destruction devices, and a sharps-by-mail or similar program because these are supplies associated with the injection of insulin. Co-sponsorship was followed by Senator Ted Kaufman (D-De) and is anticipated by Representative Diana DeGette (D-CO). In September 2008, the CBO provided Senator Isakson’s office with a score of a similar bill. With that information in hand, potential sponsors can now see a cost associated with these bills.

State legislation

Due to the increase in both needles usage among patients managing their health care at home and exposure to used-needles among environmental service workers and the general public, there is a trend among state legislators to adopt legislation that would remove needles from municipal solid waste. The

Coalition typically supports legislation that includes three components:

  1. Banning needles from household trash.
  2. Developing a needle disposal program with a plan and schedule for implementation.
  3. Developing an education program to promote safe needle disposal.

In addition we are seeing other types of legislation introduced. For example, California, Massachusetts and New Hampshire are working on legislation supporting extended producer responsibility. The map below outlines legislation currently being considered across the country.

To help achieve its goals, the Coalition strives to develop partnership with associations, such as AADE, to raise awareness, to create public education and informational programs, and to explain the importance of safe needle disposal programs. If you are interested in working with your local government to start a needle disposal program, or know of an existing disposal program in your community, please contact Jenny Schumann at jschumann@safeneedledisposal.org or call her at 800-643-1643. If you would like additional information regarding safe needle disposal programs, access www.safeneedledisposal.org or contact Jenny Schumann.



2009 Legislative Leadership Award Winners

Each year at the annual meeting AADE recognizes two active members who have made special contributions to the political process by participating, promoting and developing legislative advocacy to benefit diabetes education.

This year AADE honored Patricia Haldi, MSN RN CRRN CDE, of Washington and Carol Rasmussen, MSN NP-C CDE, of Utah with the 2009 Legislative Leadership award.

2009 Legilsative Award winner Carol Rasmussen (left) and Board of Trustees, Chair, Virginia Zamudio Lange.

Patricia Haldi, a provider of diabetes education for over 15-years, is currently the Chapter President of the Washington Association of Diabetes Educators (WADE). Patricia became active with legislative issues when she first joined her state chapter and assumed the role of legislative liaison. Since then she has been motivating members around the state of Washington to get active with issues that effect diabetes education and educators. Recently, WADE sent three members (including Patricia) to the nation’s capitol for the 2009 AADE Public Policy Forum and have since seen the fruits of their labor by having Rep. Cathy McMorris Rodgers (R-WA 5th) sign on as a co-sponsor of H.R. 2425.

Carol Rasmussen, a provider of diabetes education for 18-years, is currently one of the Chapter Legislative Coordinator's (CLC) for the Association of Diabetes Educators of Utah (ADEU) and served as the 2008 AADE Advocacy Committee Chair. Carol has been active in legislative issues for 12-years with her most notable successes being her active participation in getting the Utah state bill for diabetes education, supplies and education passed and working to delineate the insurance wording of coverage through the state insurance regulatory agency. She is motivated by the idea that each and every person has a voice that will be heard, by participating in advocacy we have the power to make things, if not perfect, more equitable.

2009 legislative award winner Patricia Haldi (right) and Board of Trustees, Chair, Virginia Zamudio Lange.

AADE would like to thank Carol and Patricia, again, for their commitment to AADE, their profession, their state and their patients.

Congratulations to you both on this much deserved award.





AADE goes to Washington!

On June 15th and 16th, with generous contributions from Eli Lilly, Roche, Medco, Takeda and Medtronic, over 75 AADE members were able to travel to Washington, DC  for the first-of-its-kind, two-day public policy forum.

The event consisted of informational sessions on healthcare reform, HR 2425 (the Medicare DSMT Act of 2009), HR1402 (the Catalyst to Better Diabetes Care Act) and how to effectively communicate these issues to Congress.
Power in numbers—forum attendees take a break for a group photo!

The first day began with invited speakers Apryl Clark, Health Legislative Assistant from the office of Senator Frank Lautenberg (D-NJ) and Mandy Spears, Health Legislative Assistant from the office of Congressman Bill Pascrell (D-NJ-8th) giving AADE advocates some much-needed insight to the current state of healthcare reform. This was followed by a introduction from AADE President Marcia Draheim, expert panel speakers and concluded with a motivational speech by Congressman Zach Space (D-OH-18th)

Cynthia Nickerson, RN CMC CDE, of Alaska takes a break from training. The only Alaskan attendee Rep. Young was of the first to sign on as a co-sponsor.

The following day, AADE members went to Capitol Hill to meet with their members of Congress. Seventy-five attendees made over 200 visits to members offices to ask for support for HR 2425, and since then, fifteen additional Congressmen have signed on as co-sponsors that include Representative Don Young (R-AK At-Large), Representative John Sarbanes (D-MD 3rd) and Representative Tom Latham (R-NE 2nd) and we are anticipating more in the coming weeks (see HR 2425 Updates).

The training and visits to Capitol Hill were a huge success, and we look forward to more Congressmen co-sponsoring the Medicare DSMT Act of 2009 in the near future.

A special thank you to all our sponsors and invited speakers:

Robert Zucker of the Diabetes Access to Care Coalition speaks to AADE forum attendees.
  • Congressman Zach Space (D-OH-18th)
  • Former Congressman Bob Franks, of counsel, Winning Strategies Washington
  • Bruce Atrim, Director Federal Affairs, Eli Lilly and Company
  • Peter Begans, Vice President Federal Government Affairs, Medco
  • Bruce Taylor, Director, Government Strategy and Relations, Roche Diagnostics
  • Deborah Outlaw, the Outlaw Group
  • Jeffrey Levi, PhD, Executive Director, Trust for America’s Health
  • Chris Porter, Director, Government Affairs, Novo Nordisk
  • Robert Zucker , Government Relations for the Diabetes Access to Care Coalition
  • Donna F. Mullins, Managing Partner, Winning Strategies Washington
  • Apryl Clark, Health Legislative Assistant from the office of Senator Frank Lautenberg (D-NJ)
  • Mandy Spears, Health Legislative Assistant from the office of Congressman Bill Pascrell (D-NJ-8th)
Advocacy Tip of the Month
  • Know the legislative process and who your state and federal legislators are.
  • Facts. Use research to help you convey your position to legislators, the public, your chapter, patients, and other AADE members. Credible data can complement personal stories about your cause, thereby making your point more convincing.
  • Identify fellow advocates and partners. Find common ground on issues to make a strong coalition.
  • Speak and act in a clear, persuasive and respectable manner.
  • Writing to legislators is the most popular choice of communication. The most effective letters:
  • State the purpose in the first paragraph
  • Are courteous and to the point
  • Include key information and uses examples to support the position
  • Address only one issue; and if possible, fits on a page
  • Building relationships is essential element of advocacy.

Advocacy is fluid and is not a one-time effort.

Advocacy involves building and cultivating relationships with those individuals that you want to inform and persuade.

Don’t take your relationships for granted, and certainly never burn bridges with anyone who may disagree with you.