After more than a year of intense debate, the President signed into law on March 30, 2010 the Reconciliation changes to the larger health reform bill that passed Congress and was signed into law the previous week. The complex legislative maneuvering to enact health care reform involved a two-pronged strategy that now sets the stage for a profound change in health care delivery over the coming decade.

While there are few provisions that directly reference the provision of ‘DSME/T’, per se, the totality of changes coming to the medical profession as a result of this bill, including those that impact nursing, nutrition, chronic disease management, prevention, wellness and the like, will undoubtedly impact the services provided by diabetes educators.

And, since it is extremely likely that there may be additional Medicare-related legislation that is considered by Congress this fall, as well as the fact that various bills to amend or change the current provisions of the law will undoubtedly continue to be introduced in the future, it is of utmost importance that diabetes educators stay focused on their primary legislative objective: namely, including CDEs as Medicare providers of DSME/T services. The CDE provision was one of the few such bipartisan measures that passed the House, and while it was favorably viewed by the Senate, it was dropped from the final bill in a misguided attempt to condense the package.

Most of the provisions included in the health reform bill will have to be implemented by the relevant federal agencies with jurisdiction over their various issues. In most cases, this will require federal rule-making, with public notice and comment before final implementation begins.

As well, the precise timing for actual implementation of all these new federal efforts varies according to the respective provisions included within the bill. The Centers for Medicare and Medicaid Services (CMS), the agency charged with overseeing the Medicare and Medicaid programs, is already struggling with the practical and logistical issues surrounding implementation of such a mammoth undertaking, and we expect additional guidance to be forthcoming in this area.

In the meantime, below are some of the highlights of the health bill that are of most interest to diabetes educators and the patients they serve. Briefly, the bill:

• Includes general insurance reforms designed to increase insurance coverage: these include elimination of pre-existing condition exclusions; elimination of life-time caps on benefits; and limitation on out of pocket expenses;
• Significantly expands the Medicaid population to all individuals under 65 up to 133% of poverty: estimates show that 15-16 million new individuals may become eligible to obtain services through state Medicaid programs;
• Establishes a new Medicaid grant program to promote healthy lifestyles: includes a variety of services, including preventing the onset of diabetes and “improving the management of their (diabetic’s) condition’;
• Establishes a National Diabetes Prevention Program: CDC is to provide grants for community based diabetes prevention, training and outreach programs’;
• Establishes a new Medicaid state plan option: patients with chronic diseases can designate a provider as a ‘ health home’;
• Promotes overall care coordination and medical home for patients: includes establishment of a new office in CMS for care coordination and other pilot efforts to promote disease management’;
• Provides for bonus Medicare payments to physicians for select primary care services as well as a short term increase in Medicaid payments to Medicare levels for certain primary care E&M (Evaluation and Management) services;
• Establishes a Patient Centered Outcomes Research Institute: intended to conduct comparative effectiveness studies as to ‘what works’ in the area of medical treatment for disease;
• Establishes a grant program for pharmacists for medication management: intended to provide a multidisciplinary approach to medication management for individuals with chronic diseases
• Reauthorizes Title VIII Nursing Workforce Development Programs and other nursing initiatives: these include a series of grant programs designed to increase the nursing workforce, promote a diverse nursing workforce, and provide for repayment of nursing student loans for those who work in health shortage areas;
• Establishes a national Healthcare Workforce Commission: new independent body of 15 members (including nurses) to assess unmet needs in the provision of health care across the country and to make recommendations to Congress;
• Establishes a demonstration program for graduate nurse education: intended to promote clinical education;
• Authorizes a School Based Health grant program: intended to provide prevention and primary services to students, focusing on the uninsured and underprivileged;
• Establishes prevention services for adults aged 55-64: a grant program for state and local governments and Indian tribes for screening, referrals and treatment for chronic disease;
• Promotes wellness and prevention by employers: allows insurance premium discounts in certain cases for wellness programs;
• Establishes a Preventive Services Task Force and a Community Preventive Services Task Force;
• Promotes prevention under Medicare: potential to expand preventive services; elimination of cost sharing for preventive services;
• Addresses childhood obesity: demonstration program to reduce obesity through education and counseling.

In 2009 AADE completed a needs assessment survey with the Member Legislative Coordinators. This survey addressed a variety of grassroots advocacy issues. As a result we are creating a three-part web-based training designed to develop a stronger group of advocates to help support and push AADE's legislative agenda for issues relating to diabetes educators/education.

The first two installments of the training series are now available on the AADE website in the Policy and Advocacy section. You can also access them by clicking on the following links:

• Part One: Understanding the U.S. Congress and How a Bill Becomes a Law
• Part Two: Grassroots Advocacy

We hope that these trainings will help your state and local legislative efforts.

Send your feedback on these webcasts to advocacy@aadenet.org

Each quarter AADE Grassroots will spotlight state level grassroots advocacy and legislation.

The first quarter of 2010 has seen a big turnout for state level grassroots advocacy. A number of initiatives in Montana, North Carolina, New Hampshire and more has helped advance AADEs advocacy efforts at the state and federal level. In addition these efforts have provided a forum to discuss issues related to diabetes educators and education with a number of legislators and their aides.

Read what your fellow educators are doing around the nation.

Florida

Florida currently has state specific legislation (SB 896) requiring the Department of Health to develop guidelines, with the assistance of certain entities, to require each district school board and the governing body of each private and charter school to provide training to a minimum number of school employees and bus drivers to recognize hypoglycemia and hyperglycemia and actions to take response to an emergency situation. The trainings will be conducted by the school nurse or other healthcare professional. To read the entire bill click here.

Michigan

Thanks to a strong grassroots effort in Michigan, Senator Debbie Stabenow (D) has agreed to cosponsor Senator Shaheen’s CDE legislation! The Michigan Organization of Diabetes Educators [MODE] will recognize Senator Stabenow at their annual conference on April 16, 2010 at The Doubletree Hotel in Bay City, MI. Chris Hennessy from Senator Stabenow's office will introduce MODE's Annual Business meeting and provide updates on their current and future initiatives.

Minnesota

In early March AADE received a request from Lauren D. Gilchrist, Health Legislative Assistant for Senator Al Franken (D-MN), to show support for the DSMT legislation. After an aggressive three-day grassroots campaign the diabetes educators and supporters from Minnesota convinced Senator Franken to contact Senator Shaheen’s office and sign on as an original co-sponsor.

Montana

On March 20, 2010, Montana hosted the Taking Control of Your Diabetes group in Kalispell city for approximatley 700 attendees. Also in attendance were Senator John Tester (D-MT) and Larry Anderson aide to Rep. Denny Rehberg (R-MT At Large). Rep. Rehberg is also a member of the Congressional Diabetes Caucus. Both were invited by AADE member and Montana diabetes advocate, Jennifer Janetski. Senator Tester spoke to the crowd as a whole and Mr. Anderson spent a good part of the day discussing diabetes with attendees. Mrs. Janetski had a chance to speak with both and is optimistic that Senator Tester and Rep. Rehberg will show support for the House and Senate bills by signing on as co-sponsors of the DSMT legislation.

New Hampshire

We are awaiting the introduction of a companion bill to H.R. 2425 to be championed by Senator Shaheen (D-NH). This legislation would mirror the language of H.R. 2425 introduced in the U.S. House of Representatives on May 14, 2009.

North Carolina

North Carolina flexed their grassroots muscles in the first quarter of 2010 by letting Senator Kay Hagen (D-NC)know the importance of increasing access to care by convincing her to be the first to sign on as an original co-sponsor of the soon to be introduced Senate DSMT legislation.

If you have an advocacy related issue that impacts or effects diabetes educators or education send your issue to advocacy@aadenet.org.