AADE e-Advocacy Newsletter

April through June 2010

AADE Advocacy at the Annual Meeting!

As you have seen over the last couple months AADE has increased its advocacy efforts this year both at the state and federal level and this will not stop during annual meeting.

What is AADE Advocacy doing in San Antonio?

  • Wednesday August 4th - Friday August 6th, Exhibit Hall Booth #1180

Stop by the AADE booth to send a letter to your Members of Congress supporting access to DSMT; Sign up to be an AADE Advocate; Get information on our state and federal legislative initiatives and more!

  • Thursday August 5th, Room 213A
3:00 PM - 4:00 PM

Advocacy Updates presented by the AADE Advocacy team

  • Saturday August 7th, Room 214CD
12:45 PM - 2:15 PM

Health Reform and Diabetes Educators: impact of recent legislation and issues yet to be addressed presented by Deborah Outlaw, JD

Want to attend these sessions and you are not registered to attend the AADE Annual Meeting? Click the icon below to register now!



Did you know AADE Advocacy has a grassroots network of nearly 15,000 users and is growing every day?

Subscribe to the AADE Advocacy Action Network now to receive advocacy action alerts, news and updates regarding critical pieces of legislation, public policy briefs and more!

Click the icon below to become an AADE Advocate! 



Or copy and paste the following URL in your web browser: www.diabeteseducator.org/advocate

Connect with AADE in other areas:

  • AADE Facebook to network with your colleagues and connect with people from all over the country who have similar interests
  • AADE Annual Meeting Twitter to receive updates and inside information on programs and events and be a part of the BIG PICTURE!
  • Join the AADE LinkedIN network to establish professional and business relationships
  • Follow AADE on twitter to receive quick and easy information regarding diabetes education and related issues


Who is Co-Sponsoring the Legislation?

H.R. 2425

Introduced on May 14, 2009 as the Medicare Diabetes Self-Management Training Act of 2009 by Representative Diana DeGette (D-CO 1st).

There are currently 45 co-sponsors for this bipartisan legislation (31 Democrats and 15 Republicans).



Don Young (R At-Large) Denny Rehberg (R At-Large)



Raul Grijalva (D 7th) Lee Terry (R 2nd)


  New Jersey

Jackie Speier (D 12th) Frank LoBiondo (R 2nd) 
Zoe Lofgren (D 16th) Leonard Lance (R 7th)
Sam Farr (D 17th)

New York

*Xavier Becerra (D 31st) Nita Lowey (D 18th)


North Carolina

James A. Himes (D 4th) David Price (D 4th)



*Michael Castle (R At-Large) *Zach Space (D 18th)



Lincoln Diaz-Blart (R 21st) David Wu (D 1st)


Peter DeFazio (D 4th)

John Lewis (D 5th) 


David Scott (D 13th) Joe Sestak (D 7th)


Patrick Murphy (D 8th)

Janice Schakowsky (D 9th) 


*Mark Kirk (R 10th) Bart Gordon (D 6th)


Steve Cohen (D 9th)

Tom Latham (R 4th)



Ron Paul (R 14th) 

Dennis Moore (D 3rd) Gene Green (D 29th)



Ben Chandler (D 6th)

Peter Welch (D At-Large)



John Sarbanes (D 3rd) 

Rick Boucher (D 9th) 

Donna Edwards (D 4th) Frank Wolf (R 10th)


Gerry Connolly (D 11th)
William Delahunt (D 10th)



Cathy McMorris (R 5th) 

Vernon Ehlers (R 3rd) 

West Virginia

Thaddeus McCotter (R 11th) Nick J. Rahall II (D 3rd)


Erik Paulsen (R 3rd)  
Keith Ellison (D 5th)  
Collin Peterson (D 7th)  


S. 3211

Introduced on April 15, 2010 as the Medicare Diabetes Self-Management Training Act of 2010 by Senator Jeanne Shaheen (D-NH).

There are currently 10 co-sponsors for this bipartisan legislation (9 Democrats and 1 Republican).



Tom Harkin (D) Ben Nelson (D) 


North Carolina

Mary Landrieu (D) *Kay Hagan (D) 


Richard Burr (R)
*Debbie Stabenow (D)



Sehrrod Brown (D) 
*Al Franken (D)  


Jon Tester (D)  

*Original Co-Sponsor

New AADE Public Policy Brief



57 million Americans are estimated to have pre-diabetes, a condition in which a person's blood sugar (glucose) level is above normal but below a level that indicates diabetes. Prediabetes may have no outward symptoms, and is diagnosed with a blood glucose test.

It is well-accepted that pre-diabetes and diabetes are on a continuum; left untreated, prediabetes will almost always become type 2 diabetes within a few years. In addition to serving as a definitive precursor to the onset of diabetes, individuals with pre-diabetes are at increased risk for a variety of cardiovascular problems, high cholesterol, and polycystic ovarian syndrome for women.

Read the Entire Pre-Diabetes Public Policy Here


Energy and Commerce Diabetes Hearing

On Thursday July 1, 2010 the House Energy and Commerce Subcommittee on Health held a hearing entitled “The Battle Against Diabetes: Progress Made, Challenges Unmet.” The hearing heard about advances in research into type 1, type 2, and gestational diabetes, as well as other related public health efforts. It also explored the understanding of the causes and consequences of diabetes, as well as evidence-based prevention and management strategies.

Representative Diana DeGette (D-CO) asked AADE to provide her with language regarding the importance of the CDE/DSMT bill for her opening statement as well as written testimony from AADE. Both will become part of the official hearing record.

Read the entire AADE statement here.

Congressional work almost completed for 2010!

Only half a year remains in the current session of Congress. Once Congress adjourns, all bills that have not been voted on will essentially 'die,' and must be reintroduced again in the 112th session of Congress that begins in January 2011.

The Medicare Access to Diabetes Self-Management Training Act has been introduced in the Senate as S. 3211 and in the House as H.R. 2425. We must increase the number of Congressional co-sponsors for these bills if they are going to pass Congress this year. That is where you come in! We need your help in contacting your Senators and Representatives and asking them to co-sponsor our bill.

Because it can be confusing to understand the legislative process, we thought it would be helpful to answer some general questions about bills and the process for getting them passed.


This year, over 5,400 bills have been introduced in the House. Over 3,400 have been introduced in the Senate. And more bills are introduced daily. Of these only a very tiny fraction will ever actually be 'voted on.'

Most bills that are voted on are often combined into larger packages to streamline congressional action.


To compete for space in one of these larger packages, Congress must generally agree that 3 main goals have been met:

  1. The policy behind the smaller bill has merit: i.e. carefully crafted educational documents showing the need for the bill.
  2. The politics behind the bill has merit, i.e. enough constituents have contacted their Congresspersons and asked them to pass the bill.
  3. The process exists to pass the bill, i.e. a larger Medicare bill is moving through Congress, which can serve as a 'vehicle' on which to attach our bill.

The first goal has been met by the efforts of AADE staff and volunteers. Now, it’s time to work on goal #2. We need the diabetes education community to show interest and support for these bills so that we can include our bill in a larger one when the opportunity arises (goal #3).


The Internet has dramatically increased the ease with which constituents can contact their Members of Congress. Most Congressional offices now receive several thousand emails a day.

Unfortunately, in some ways, the ever-increasing communication traffic is so heavy that it is very easy for emails or faxes to be generically batched and a 'form letter' used as a reply. A form letter usually includes a sentence to the effect that the Member appreciates being informed of (fill in the blank) issue and will certainly consider the bill if it 'comes up for a vote.' This type of letter does not help advance our cause - it says nothing and promises nothing.


In your email or fax, take the time to add a personal sentence to describe your own diabetes education program, the patients you serve, and why S. 3211/H.R. 2425 will help increase access to care for the many people in your area who desperately need to learn how to control their diabetes. Be sure and ask your Member to "Co-sponsor" S. 3211/H.R. 2425 respectively. Do not simply ask for their "support" by itself; you will likely get a form letter in response.

Follow up with the Member's Health Legislative Assistant by phone. If at all possible, do not simply call and leave a message at the front desk.

Get on board with the many "Non-Washington" based activities that you can to communicate with your Members when they are home, such as:

  • Attend Town Halls or other regional events where you can ask a question or make a statement about the need to co-sponsor S. 3211, H.R. 2425.
  • Find out if your Member does online chats and join in.
  • Make an appointment with senior staff in one of the local offices. Many junior level staff often work in the district offices, handling personal constituent problems such as Social Security check issues. However, the more senior Office Directors are the ones keeping their finger on the pulse of important issues that matter to their constituency, and they can be very helpful in making sure that your concerns are carried to D.C.
  • Meeting with the local district staff is especially important if you feel you have received the 'form' letter response noted above, or no response at all.

The old axiom is as true in Washington as anywhere else: The squeaky wheel gets the grease.

Of course, this is not a license to be rude, threaten to withhold your vote, or make similar statements. Because the Diabetes Education bill is bi-partisan, widely supported among major health and diabetes groups, and does not impact the federal deficit, your message can always be an extremely positive statement about the benefits this bill will bring to patients in your state who need DSMT.

The only hurdle we must overcome in gaining co-sponsors for S. 3211/H.R. 2425 is simply that our bill is small, relative to other larger bills now under consideration. So, it is easy for it to be overlooked among other competing health interests. That is why your persistence is so vital.

AADE has a sample letter that is easy to send to your Senators or House Representative. Take a moment to personalize the letter and follow it up with a call to your Congressperson’s Health Legislation Assistant.

Thank you for your ongoing help in making the Diabetes Education bill a reality and helping us all ensure that individuals with diabetes are able to receive the quality care they need!

Why Diabetes Self-Management Training (DSMT)?
Issue Background

Section 4105 of the Balanced Budget Act of 1997 (BBA) provided coverage and reimbursement for diabetes self-management training (DSMT) by physicians and other healthcare providers who are currently eligible to bill Medicare for services or supplies, provided that DSMT is furnished incident to other covered services, regardless of whether those items or services are related to diabetes care. While the intent of the legislation to include outpatient clinic settings was achieved, the spirit behind the need for such legislation was not met. The statutory provision did not recognize certified diabetes educators (CDEs), the largest and most qualified group of healthcare professionals to provide DSMT.

As a result of the BBA language and subsequent final rule, all recognized providers including RDs, LPNs, Pharmacists, durable medical equipment (DME) suppliers and other healthcare professionals with an NPI number, can bill Medicare for DSMT, provided the Center for Medicare and Medicaid Services(CMS) guidelines are met. CDEs, however, represent the only group of healthcare professionals who provide diabetes self-management training that have not been recognized as DSMT providers and, therefore, are precluded from billing Medicare for DSMT.

Policy Justification

A comparison of the training requirements of CDEs to those of other healthcare providers further underscores the shortcomings of the current rule and suggests the need for modification of the underlying statute. Certified diabetes educators must be licensed or registered, or have received an advanced degree in a relevant public health concentration; have professional practice experience and have met minimum hours requirements in DSMT; and have met certification and recertification requirements.

As a result of CMS Rule 42 CFR § 410.140, highly trained and experienced CDEs cannot bill Medicare for DSMT, while others may provide DSMT and be reimbursed by Medicare through their facility for such services.

The current number of healthcare professionals who provide DSMT, even considering the roughly 16,000 CDEs currently in the US, is grossly inadequate to meet the projected 165% increase by 2050 in the number of people with diabetes (from 20.8 million to 29 million). Reimbursement to CDEs for DSMT will attract a greater number of qualified diabetes educators to the field and will prepare patients to successfully manage their diabetes and reduce acute and secondary complications. The cost of a patient completing a DSMT program is less than the average cost of an emergency room visit for an acute complication. DSMT will not only dramatically decrease healthcare costs but will improve quality of life among persons with diabetes.

Why Diabetes Self-Management Training?

Diabetes is recognized as one of the top public health threats facing our nation today. Just fewer than 24 million Americans are living with the disease (7.8% of the population), a number that is estimated to increase to 9 percent of the U.S. population by the year 2025. In 2007, diabetes accounted for approximately $174 billion in direct and indirect healthcare costs. These costs are expected to double in the next five years.

DSMT plays an essential role in the management of diabetes DSMT is integral to the medical plan of people with diabetes. DSMT serves as the first line of defense in preventing costly and debilitating conditions, including cardiovascular disease, kidney failure, blindness and lower limb amputations. It also helps prevent emergency room visits related to acute complications such as low blood sugar reactions and acute consequences of extremely high blood sugars.

DSMT seeks to ensure patient adherence with individual treatment plans that lead to healthy, active and productive lives. There is now a substantial body of evidence that DSMT is effective – but that is only as long as the patient has access to it. Providing more self-management opportunities for people with diabetes through reimbursement of CDEs ensures patient access.

Recommended Action
The American Association of Diabetes Educators strongly urges the immediate recognition of certified diabetes educators (CDE), credentialed by a nationally recognized certifying body for diabetes educators, as providers by CMS.
These highly trained healthcare professionals should be reimbursed by Medicare for providing diabetes self-management training (DSMT). This would increase access to an essential service that addresses the growing public health challenges associated with the disease.
The American Association of Diabetes Educators calls on Congress to:
Enact S. 3211 and H.R. 2425 to amend the Social Security Act, Title XVIII, to recognize Certified Diabetes Educators as Medicare providers for purposes of diabetes outpatient self-management training services.