AADE e-Advocacy Newsletter

April through June 2011

A Letter From AADE President, Donna Tomky, MSN RN C-NP CDE FAADE 

I know that many of you are talking about our State Licensure Initiative, and you have some questions. In the articles below, we will present the ins and outs of the initiative so that every AADE member will have the same answers.

First, I’d like to share with you the principles that have guided us in this effort:

  • Diabetes Self-Management Training (DSMT) has demonstrated health benefits for individuals with diabetes and results in cost savings to the healthcare system.
  • The growing number of people with diabetes need and deserve access to diabetes self-management training.
  • There are not enough qualified diabetes educators to deliver these needed services to the growing population with diabetes.
  • At this time, anyone can call themselves a diabetes educator and the scope of practice varies greatly among programs and practitioners.

 AADE represents diabetes educators and supports the delivery of quality DSMT. We are dedicated to growing the specialty into a standardized, more recognized profession and encourage more healthcare professionals to enter the field. More qualified diabetes educators mean better patient care and outcomes.

The State Licensure Initiative evolved directly out of our efforts to meet this need. In the articles that follow, you will find an overview of the licensure process, AADE’s recommendations for the licensure requirement, the process for establishing a state license for diabetes educators, and the various resources that exist to help you learn even more about the initiative.

Thank you for reading the Advocacy Newsletter!

Donna Tomky, MSN RN C-NP CDE FAADE, AADE President

Overview of the Licensure for Diabetes Educators Effort

AADE has long spearheaded efforts to increase recognition for diabetes education through advocating for passage of federal legislation – the Diabetes Self-Management Training Act – that seeks Medicare provider status for CDEs performing outpatient diabetes education.

However, the main barrier we’ve found to gaining provider status is that there is no legal definition/scope of practice for diabetes education. Other healthcare professions have licensure or registration requirements and a professional scope of practice that give them a legal standing for recognition by the Centers for Medicare and Medicaid Services.

We recognized the need to establish a legal definition for the professional and a codified scope of practice. The only way to accomplish this is through establishing state licensure for diabetes educators.

State licensure ensures that all healthcare providers who deliver diabetes education will have sufficient knowledge to provide safe, effective care to persons with diabetes. It also offers patients a measure of protection by ensuring that the diabetes education they receive is provided by a qualified professional with adequate training to meet a standard level of diabetes care.

Licensure would set the quality standards and the scope of practice for the diabetes educator—a nd it creates the legal definition that we need in order to successfully advocate for increased reimbursement and provider status for diabetes educators.

However, establishing state licensure is not an overnight endeavor—nor is there a standardized procedure that can be followed in all states, as each state has their own legislative and regulatory process. Once the process has been initiated, it could take several years until all of the details have been worked out and implemented.

Through grassroots advocacy and targeted lobbying efforts on the state level, legislation must be drafted, endorsed, and passed. After the legislation is passed, the regulatory bodies will set the specific qualifications for the license in that particular state.

Again, the requirements for diabetes educator licensure will be determined on a state-by-state basis during their regulatory process. However, AADE has proposed certain qualifications and standards for individuals seeking a diabetes educator license.

AADE Recommendations for State Licensure Requirements

AADE believes that DSMT is a crucial element in the health care of people with diabetes; it has demonstrated health benefits for individuals and results in cost savings to the healthcare system. AADE also recognizes that there are not enough qualified diabetes educators to deliver these needed services to the growing population with diabetes.

Licensure sets the quality standards and the scope of practice for the diabetes educator. It also sets the baseline requirements for professionals who may pursue an additional credential to demonstrate their professional development and career advancement.

AADE does not have power over how the licensure standards are set. However, in an effort to (1) assist in defining this legal scope of practice for the qualified diabetes educator, (2) protect the patient, (3) help guide the process of establishing minimum quality standards for the delivery of DSMT, and (4) protect the diabetes educator, AADE will advocate that the following recommendations be considered by state regulatory licensing boards:

  • Healthcare professional disciplines include, but are not limited to registered nurses, registered dietitians, registered pharmacists, licensed mental health professionals, and exercise physiologists.
  • Bachelor’s degree or education that meets the states healthcare professional licensure requirements for the primary discipline. Completion of AADE’s Core Concepts Course or a diabetes education program sponsored by any advanced academic or continuing education organization that meets state-determined standards and provides a minimum of 15 hours of learning in the biological and social sciences, communication, counseling, and education.
  • 5 hours of continuing education related to diabetes self-management education and training each year
Professional Practice Experience:
  • 250 hours – within a two (2) year time frame; specific to diabetes self-management education and training. As evidence of experience in the care of people with diabetes.
The Licensure Issue—In Brief

Here is a high-level summary of the issues surrounding the state licensure initiative.

  • Right now, anyone can say that they are a diabetes educator. There are thousands of healthcare professionals in the U.S. who are providing different levels of care and education to people with diabetes. But there is no “proof” that they are qualified to deliver DSMT. There are no requirements that they must meet to claim the specialty and no specific coursework required for them to complete.
  • In reality, this means that diabetes education is essentially an unregulated and largely unrecognized profession. There is no legal definition of the profession because it does not have a standardized scope of practice.
  • Professionals who have earned the BC-ADM and CDE® credentials have demonstrated exceptional knowledge and experience in the field. However, the credential is not required to practice diabetes education.
  • Even though healthcare professionals have to be licensed in their respective fields to be eligible to sit for a credential, professional licensure boards (such as those for RNs and LDs) have no jurisdiction over the practice of diabetes education or the diabetes educator. 
  • If licensure was limited to only those who have earned the BC-ADM and CDE® credentials, the workforce of diabetes educators would be severely limited with little hope of meeting the needs of the growing diabetes population--as there are only about 17,000 credentialed diabetes educators in the country and nearly 26 million Americans with diabetes.
  • Licensure would set the minimum quality standards and the scope of practice for the diabetes educator. It is designed to ensure that everyone who claims to be a diabetes educator and delivers diabetes education is adequately qualified and prepared before they can claim the professional designation.
  • The requirements for diabetes educator licensure will be determined on a state-by-state basis during their regulatory process, after the legislation has been passed. AADE does not have power over how the licensure standards are set.
  • The licensure standards for each state will be determined during their individual regulatory processes, but AADE has made specific recommendations for the requirements for licensure. 
  • AADE recognizes that professionals who have earned the BC-ADM or CDE® credential would surpass the minimum qualifications for licensure and has reflected this in our recommendations for state licensure requirements
The Licensure Process: How to Get Started in Your State!

As we move forward with the State Licensure Initiative it is imperative that the AADE membership not only understands the process of how licensure legislation gets passed but knows that we are here to help guide and support the efforts from beginning to end!

The first step in starting the licensure process would be to contact James Specker, AADE Advocacy Specialist, at advocacy@aadenet.org or (312) 601-4873 to begin creating a strategy and to determine how best to approach the licensure effort in your state. Each state is unique and the processes will vary but the core of all the efforts is as follows:

  1. First, determine whether the diabetes educators in the state are interested in pursuing this initiative. Legislation rarely gets passed unless there is public demand.
  2. Work with AADE to educate yourselves on how licensure is handled in your state and determine the requirements for comparable licenses (RN, LD, LPN, etc). This helps in modifying the draft legislation to be applicable to your states process. If funding is available for a contract lobbyist, that individual or group would guide the drafting of the legislation
  3. Identify key individuals who reside in your state and will serve as liaisons and content experts when communicating the issues with the state legislature. These will include diabetes educators but also should include patients, parents of children with diabetes, program coordinators, etc. AADE can assist with the training of these spokespersons if they do not have any prior experience in the political arena.
  4. With the guidance of AADE and/or the state lobbyist, identify legislators – one each in the Senate and the House – who will serve as the bill’s sponsors and champions. You will work with them to draft the legislation. We can provide you with:
    • Draft legislation used in other states
    • Recommendations on requirements for licensure
    • Fact sheets and needs assessments
  5. Work with your champions to build support and seek co-sponsors for the legislation. AADE will guide you through the process, including:
    • Generating an information blast to targeted areas in your state or through sending action alerts
    • Providing contact information for relevant members of the state legislature
  6. Once the legislation is introduced it will go to the appropriate committee, depending on the state’s processes, for consideration and then, if applicable, to the floor for a vote. During this time, the content experts need to be available, lobbying for the legislation with relevant committee members and testifying at hearings in summoned. Representatives from AADE headquarters and/or Board of Directors are available to accompany this group during the meetings or hearings.
  7. The regulatory process is the last step and will begin once the bill is passed in both the State Senate and House, and after the Governor signs the bill.
Town Hall Licensure Call

On June 8, 2011 AADE hosted a town hall call on the state licensure initiative for AADE members.

Speakers included AADE President Donna Tomky, past President Deb Fillman, Vice President Tami Ross, Chief Executive Officer Lana Vukovljak, and Chief Advocacy Officer Martha Rinker.

This was an opportunity for AADE members to learn more about the initiative, ask questions and find out how to get a Diabetes Educator licensure effort started in your state.

Click on the podcast button below to listen to the entire call with questions from AADE members and answers from the panel.

Diabetes Advocacy Alliance

The American Association of Diabetes Educators is a member group and co-chair of the Diabetes Advocacy Alliance (DAA). The DAA is a broad coalition of diabetes related organizations formed to help address the growing health and economic threats from Diabetes Epidemic.

The following is a press release for the official launch of the DAA website.

(WASHINGTON) As part of its fundamental mission to inform policymakers about the severity of the US diabetes epidemic and offer sound solutions, the Diabetes Advocacy Alliance™ (DAA) has launched www.diabetesadvocacyalliance.org , a Website that will help serve as a resource for diabetes-related news and policy information.

The American Association of Diabetes Educators (AADE) is a member of the DAA, a diverse, 14-member group of patient advocacy organizations, professional societies, trade associations, nonprofit organizations, and corporations, sharing a common goal to defeat diabetes.

"Diabetes is a huge and growing problem," said Martha Rinker, DAA co-chair and Chief Advocacy Officer of the American Association of Diabetes Educators. "In many ways, diabetes is bigger than all of us. That's one of the primary reasons why this broad coalition of organizations has come together and one of the reasons we believe it is critical to inform policymakers about the human and economic impact."

According to the Institute for Alternative Futures (IAF), the number of people with diabetes will swell by 64% to more than 50 million Americans in the year 2025. The costs will swamp the health care system, with a price tag of almost $514 billion—an amount comparable to the total budget of today's Medicare program and a 72% increase from 2010, according to IAF data.

The website will provide information on the costs and impact of diabetes, as well as information about the diabetes-related activities of its members, including the AADE.

"We've seen policy reshape how this nation prevents public health challenges-- such as car passenger safety through seat belt laws, preventing seasonal flu through vaccination, and saving children's lives through car seat and bicycle helmet requirements," said DAA co-chair, Dr. Michael Duenas, Associate Director, Health Sciences and Policy at the American Optometric Association. "We need to have that same sort of attention paid to those at risk for type 2 diabetes."

For more information please visit the DAA website: www.diabetesadvocacyalliance.org