Exciting news, the Affordable Health Care for America Act (H.R. 3962) passed by the House of
Representatives includes the CDE provision to improve access to diabetes self-management training
(DSMT) by designating all certified diabetes educators as certified Medicare providers for purposes
of outpatient diabetes self-management training.
Why do we say exciting? Because having CDE’s designated as a certified provider of DSMT is
critical to raising the visibility and value of diabetes education and positioning its role in the
changing landscape of health care.
The Minnesota Department of Health in collaboration with our local AADE chapter, Minneapolis/St.
Paul Diabetes Educators, recently completed an independent survey to assess the scope of service
reductions, if any, and to determine the potential impact on diabetes care. The findings confirm
the changes we are seeing and the concern for ongoing care for people with diabetes: education
programs are having to do more with less; many are seeing reductions in staff; longer wait periods
for patients; decreased access to services; increased reliance by providers to assist in managing
their patients and poor reimbursement which only fosters further program reductions. Reality and
tough to read, yes! Yet, what appears to be the end may just be the beginning. How can we maximize
Right now, it is more important than ever to contact your Senator and ask that they support the
CDE language in the Senate version of the Healthcare Reform Bill. Don’t count on someone else doing
it for you. The future of your skills, as qualified diabetes educators, being utilized to meet
patients’ needs is dependent on you taking action now! If you have done so already – thank you.
Keep the momentum moving and engage others to offer continued support.
If you haven’t sent that email or made that phone call yet, spend five minutes reading and
thinking about the information below. Then, determine your response.
Thoughts to Ponder
Actions to Consider
No Time. I have patients to see, charting to do, meetings to attend.
Diabetes educators have been on a treadmill for years, 10 hour days trying our best to meet
multiple demands – has it paid off?
Stop! Take time to send an email. Tell your story and why increasing access is important.
Share outcomes and your value to patients.
Use your skills, right now, to make a greater impact for patients in the future.
DSMT payment is inadequate – focusing there first versus getting CDE legislation
You’re right but doing so is perceived as self-serving and it is not the next step. Can you
imagine legislators responding to this request in this economy?
Improve access first to broaden our reach and further build the evidence to demonstrate the
value of adequate reimbursement.
Why bother with having CDE’s as providers? We have payment already under our medical
Think beyond your current scope.
Think new opportunities. Doors will open. You may wish to accept payment direct or you may
be able to assign payment to other entities.
The cost of co-pays and the fact a growing number of patients are without insurance is causing a
decline in referrals. How will CDE as provider help?
Health care reform has renewed emphasis on quality.
CDE’s becoming providers enhances your visibility and strengthens your position as a key
Pay for performance is catching on even Medicare is beginning to pay for quality.
Organizations and small physician practice groups are beginning to position for success.
Pharmacy studies have shown great results with no co-pays or charge for educ. CDE’s could
do the same. We need to replicate!
Seek opportunities for pilot-projects to demonstrate the value of the CDE.
Think how the CDE role can support the medical home concept
NP’s and PA’s can provide education billing E & M codes as counseling and getting paid at
much higher levels than the DSMT G codes.
It’s true, payment is higher, and, there may be perceived value by the patients.
Yet, is this the best use of their time?
Will they still be expected to see all types of patients?
How will they maintain their expertise and stay updated on new approaches to management?
With the growing shortage of primary care providers, is this the best use of an NP or PA’s
Will this approach be the best ROI for their time?
Could the role be better filled by CDE’s or CDE’s being a liaison to medical home coordinators?
Diabetes educators may be taking a short-term view.
Note, AADE has surveyed diabetes educators – our mean age is 54 years.
Diabetes educators are known to be facilitators of change. This is no time for
CDE Provider Status:
Increases awareness of the value of CDE’s and DSME which, in turn will…
Attract new health professionals to the role of the CDE…
Fostering oversight and providers of quality diabetes education and care.
Take action by:
1. Going to the AADE Advocacy
2. Follow the simple steps to send an email to your Senators –it will send the email direct
to your Senators with no need for you to look for their email address; there is a template there
for you to use or you can tailor it to develop your message.
3. It takes no more than 5 minutes. Doing so may ensure your ability to continue to do what you
love most – making a difference in the lives of people with diabetes.
Jan Pearson, BAN, RN, CDE
Incoming AADE Board Member
Member, 2009 AADE Advocacy Committee
International Diabetes Center
The CDE provision, which was included in the Senate Finance Committee (SFC) version of health
care reform, has been omitted from the final 'merged' bill between SFC and the HELP Committee. We
are told this is not due to any policy concerns or opposition to this provision by any
Instead, it has been erroneously assumed by some that the provision may not be essential to the
provision of DSMT care.
It is extremely urgent that you contact your Senators now and express your serious concern, and
to request that the CDE provision be inserted into the Senate bill. In addition to sending an
email, we encourage you to call Senate offices.
Silence on the part of AADE members indicates that we agree with the assumption that the CDE
provision is not a vital part of health care reform. With the Senate poised to take up the health
care bill, time is of the essence to weigh in.
AADE will continue to monitor the progress of this legislation as it moves through Congress and
communicate that to membership as needed and available. Our efforts are not done yet so what we
need from AADE members and supporters is to continue to take action by sending letters to your
Senators and ask that they support the CDE language in the Senate version of the Healthcare Reform
Let your Senator know the importance of including the CDE provision in the final Senate
You can do so by
The U.S. House of Representatives, recently, passed the Affordable Health Care for America
Act (H.R. 3962) that includes the CDE provision to improve access to diabetes self-management
training (DSMT) by designating all certified diabetes educators as certified Medicare providers for
purposes of outpatient diabetes self-management training services.
Below is an updated listing of all co-sponsors for AADEs legislation H.R. 2425: Medicare
Diabetes Self-Management Training Act of 2009
Rep DeGette, Diana [CO-1] Introduced 5/14/2009
Rep Castle, Michael N. [DE] - 5/14/2009
Rep Kirk, Mark Steven [IL-10] - 5/14/2009
Rep Becerra, Xavier [CA-31] - 5/14/2009
Rep Space, Zachary T. [OH-18] - 5/14/2009
Rep Young, Don [AK] - 6/17/2009
Rep Terry, Lee [NE-2] - 6/17/2009
Rep Moore, Dennis [KS-3] - 6/17/2009
Rep LoBiondo, Frank A. [NJ-2] - 6/24/2009
Rep Sestak, Joe [PA-7] - 6/24/2009
Rep Paulsen, Erik [MN-3] - 6/24/2009
Rep Boucher, Rick [VA-9] - 6/26/2009
Rep DeFazio, Peter A. [OR-4] - 6/26/2009
Rep Latham, Tom [IA-4] - 7/8/2009
Rep Sarbanes, John P. [MD-3] - 7/9/2009
Rep Welch, Peter [VT] - 7/9/2009
Rep Farr, Sam [CA-17] - 7/15/2009
Rep Wolf, Frank R. [VA-10] - 7/15/2009
Rep Connolly, Gerald E. "Gerry" [VA-11] - 7/22/2009
Rep McMorris Rodgers, Cathy [WA-5] - 7/30/2009
Rep Paul, Ron [TX-14] - 9/9/2009
Rep Wu, David [OR-1] - 9/9/2009
Rep Murphy, Patrick J. [PA-8] - 9/14/2009
Rep Lofgren, Zoe [CA-16] - 9/14/2009
Rep Scott, David [GA-13] - 9/25/2009
Rep Speier, Jackie [CA-12] - 10/6/2009
Rep Lowey, Nita M. [NY-18] - 10/6/2009
Rep Green, Gene [TX-29] - 10/6/2009
Rep Lance, Leonard [NJ-7] - 10/22/2009
Rep Chandler, Ben [KY-6] - 10/22/2009
Rep Delahunt, Bill [MA-10] - 10/22/2009
Rep Grijalva, Raul M. [AZ-7] - 10/29/2009
Rep Lewis, John [GA-5] - 11/18/2009
Rep Edwards, Donna F. [MD-4] - 11/19/2009
This month AADE Advocacy is spotlighting Jenifer Janetski, RD CDE, the Chapter Legislative
Coordinator from the Montana Chapter of Diabetes Educators (MAADE). Jennifer and her fellow
constituents and peers were instrumental in obtaining Senator Baucus' support of the CDE
legislation language to be included in the Senate Healthcare Reform Bill.
Jennifer, how did you get interested in becoming a CLC?
I have been the CLC for the past 2 years, I never had done anything like this before, but I was
asked by the prior legislative chair and she was encouraging and would not take no for an
How did you manage to convince Senate Baucus of the importance of this
My father and Senator Baucus had worked together on issues with the timber industry in Montana.
This was a good way for me to get my foot in the door. It is important to use any connection you
may have in order to get your legislator’s attention.
What strategies did you use?
I met with the past legislative aide of Senator Baucus, Rebecca Manna, who is now working as the
government affairs person for Kalispell Regional Medical Center. She was very helpful in offering
some helpful tips.
- Inform the legislator’s office that you have been appointed to the position of Chapter
Legislative Coordinator for the American Association of Diabetes Educators – this gives you
credibility and you are now the expert he/she will call on
- If you have personal connections to the legislator use that as a way to contact the Senator or
- Acquire your state statistics on diabetes – gather diabetes facts, statistics these may be
found at the CDC state diabetes control program
- When having your conversation with the legislator it is important to provide both the up and
the down side to the bill
- Get your chapter members engaged in the process and encourage them to think about a way to
personalize their communications by telling a story or providing an example of how they made a
- Be sure to thank your members for their support
Had you ever had experience with advocacy prior to you taking the CLC position for your
No, this was the first time I had ever done anything like this. I had to learn a lot. There is
good information on the AADE Advocacy website and I spent time on the phone with James Specker from
AADE and Debra Outlaw who works with Martha Rinker, our Advocacy officer. They were very helpful in
providing information on how the legislative process works and how to advocate for our cause.
They also provided contact information for the health legislative aide, it is important that you
are in contact with the correct person in the office. I also learned a lot attending the AADE
Public Policy Forum in June 2009.
How did you get your chapter involved in this effort?
It is important to do your homework. I established a committee to help and tried to have someone
from each part of the state involved. Montana has only one chapter and we only meet once a year so
I created an email list and a phone tree so I would be able to contact everyone quickly if we
needed to respond to an issue or a request. I also made contact with key people in the state; we
have a CDE involved with the Diabetes Project so she was instrumental in providing detailed
statistics on how diabetes affected residents of Montana.
At our yearly meeting we had 80 members attend and I was on the agenda to explain about the
legislation and why it is so important to us. I really tried to stress to members that no one else
was going to fight for this legislation but us and we needed to brag about our efforts as we do
make a difference. I was able to get members to sign a note to Senator Baucus encouraging him to
keep the HR 2425 language in the Health Care Reform bill at the meeting and sent the print version
to James to have included.
I also send out emails informing our members of what is happening and what we need. I encouraged
feed back on my emails as to who contacted their senator and will plan to have a read receipt on
the next set of emails I send, since this will help our members further understand the importance
of responding to legislative issues.
I provided a template of a sample letter or email and the contact information of all the
legislators. I also provided some talking points and encouraged them to take what had been provided
and make it their own personal message. I also asked members to consider other organizations that
may support our cause. I think it has been the support shown by our Montana members that ensured
Senator’s Baucus’s support. Our members were very responsive in communicating with his office.
Jennifer, do you have any other words of wisdom to share with other CLC’s?
It is important to realize you can make a difference. When I took this position, I spent time
thinking about what I saw as important for the residents of Montana regarding diabetes education.
Also there is good information available that will help you be a better CLC – sign up for advocacy
alerts from ADA and other healthcare organizations in order to stay informed, the New York Times,
Healthcare section is worthwhile reading online. Thomas.gov website is a way to track progress of
which legislators are co-sponsors and list all legislation submitted. Go to the CEO of your
organization and ask them to write a letter of support, you are an asset to your organization, it
is important that they support your efforts. Be consistent, it is the squeaky wheel that gets the
attention, be the squeaky wheel.
I would like to thank my committee for all the help they have offered - Lisa Ranes, RD CDE,
Karrie Fairbrother, RN CDE and Susan Garnic, RD CDE. Two other people are Marci Butcher, RD CDE who
is with the Montana Diabetes Project and Helen Amundson, RN CDE who is a past president of MAADE
and always is making contact with our congressmen. She works at a community Health Center in the
Interviewed by Kathy Gold, RN MSN CDE, Chair, 2009 AADE Advocacy Committee
In 2009, Mississippi was ranked number one in obesity in the U.S. for the fifth straight year by
the Robert Wood Johnson Foundation and the Trust for America 's Health. Mississippi has a diabetes
prevalence rate of 11.3% as opposed to 8.2% nationally.
CMS is heading up a collaborative (Health First) to address this problem. The goal is to provide
increased access to diabetes education for people in Mississippi.
The American Association of Diabetes Educators (AADE) is honored to be a partner in this
critically important initiative, along with an impressive list of stakeholders, and stands
ready to support the effort in any way that we can.
AADE is particularly supportive of the program’s aim of increasing access to diabetes education
and the services of diabetes educators because we know that relationship is the key to a patient’s
successful management of their diabetes.
Not only is providing diabetes education the right thing to do, but diabetes education has been
proven to lower average health care costs, improve clinical outcomes and reduce the need for costly
health care associated with diabetes-related complications.
In fact, AADE just completed a study that showed that Medicare patients who participated in
diabetes education cost the healthcare system 14 percent less than those who didn’t
We are in the process of recruiting diabetes educators throughout Mississippi to participate in
the program so that we can ensure the maximum number of Mississippians achieve optimal health
status and a better quality of life with their diabetes.
AADE is also looking to recruit educators throughout Mississippi and the surrounding
counties in other states to establish accredited DSME/T programs that can serve the people of
Mississippi. We also would like to ensure that all local and surrounding diabetes educators are
informed about the program and opportunities for them to participate in it.
Administration on Aging (AoA)
American Association of Diabetes Educators (AADE)
Centers for Medicare & Medicaid Services (CMS)
Health Resources and Services Administration (HRSA)
Housing and Urban Development (HUD)
National Association of State Health Policy (NASHP)
National Institutes on Health (NIH)
Office of Minority Health (OMH)
AADE Advocacy is spotlighting an article from the
Kaiser Health News
The article, written by Frank Browning on Novemeber 13, 2009, can be found