AADE e-Advocacy Newsletter

July through September 2011

Support Access to Diabetes Self-Management Training (DSMT)

Two-months have passed since the Diabetes Self-Management Training Act of 2011 was introduced in the House and Senate. More co-sponsors are needed. We are rapidly nearing the end of the first session of the 112th Congress* and it is critical that we take action now so we can come out of the gate strong in 2012!

Recap: 

On August 1st, H.R. 2787 was introduced by the Representative Ed Whitfield (R-KY-1) and original co-sponsor Representative Diana DeGette (D-CO-1). On August 2nd, S. 1468 was introduced by Senator Jeanne Shaheen (D-NH) and original co-sponsor Senator John Tester (D-MT).

The legislation stands to Amend title XVIII of the Social Security Act to improve access to diabetes self-management training by authorizing credentialed diabetes educators to provide diabetes self-management training services, including tele-health services, under part B of the Medicare program.

Why do we need this legislative fix?

When Congress enacted DSMT as a Medicare benefit in 1997, the legislative language was broadly referred as “Medicare providers” of DSMT. Since ‘Diabetes Educators’ were not named as “Medicare providers,” they do not exist in the statute and cannot be reimbursed by Medicare.

Ensuring that credentialed diabetes educators are recognized as DSMT providers will promote greater quality of care in the Medicare program. Federal recognition of credentialed diabetes educators as Medicare DSMT providers will likely strengthen state Medicaid DSMT programs.

How do we know that a credentialed diabetes educator will be truly qualified to provide DSMT?

In order to get a Medicare provider number the bill requires that an individual must first be a state-licensed or registered health care professional with a federally approved certification as well as extensive clinical instruction and continuing education in a diabetes curriculum. Currently there are two diabetes education certification options, the BC-ADM and the CDE.

Take action now!

Now is the time that we ALL must become advocates and finally get the recognition and reimbursement you deserve!

We need you, your family, friends and patients to call and write your legislators, make visits and share your personal stories with your Congressperson and Senators. Let your voices be heard; only YOU can affect this change—there is no better lobbyist than you!

The letters can be edited, so please take some time to add a personal touch.

Click the following links to take action.

For House Bill 2787
For Senate Bill 1468 

Please contact AADE Advocacy Specialist, James Specker at advocacy@aadenet.org if you have any questions regarding this legislation or communicating with your Member of Congress.

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* Each Congress lasts two years and is comprised of two sessions. The first session convenes on Jan. 3 of odd-numbered years and adjourns on Jan. 3 of the following year, while the second session runs from Jan. 3 to Jan 2. If both chambers do not pass the exact same version of the bill by the end of that Congress the bill dies and the process starts all over again.

Read more:  How Our Laws Are Made 

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AADE Advocate Spotlight!

AADE Advocacy is spotlighting Donna Tomky, MSN RN, C-NP CDE FAADE, AADE President and Advocate in the State of New Mexico. Leading the charge, Donna and her fellow New Mexicans were instrumental in obtaining Rep. Martin Heinrich (NM-D-1st) and Rep. Ben Lujan's (NM-D-3rd) co-sponsorship of H.R. 2787 the Medicare Diabetes Self-Management Training Act of 2011.

With today’s the political climate, grassroots efforts are more important than ever! The New Mexico AADE members have shown how mobilizing the community has a positive effect on legislators decision making. Engaging your diabetes educator community increases the strength and influence of the grassroots effort.

In Donna’s words, "[All of the Members of Congress we met with] knew someone with diabetes, with most having family members with [diabetes] and one aide having pre-diabetes. It really hit home in a state with a high Hispanic and Native American population...I sent follow-up emails after the meetings, and of course send information on the bills."

The key to the success of these folks in New Mexico was sticking to the basics and that is bringing a personal element into the equation; being the expert and providing "just the facts" and follow-up.

For more tips on how to effectively organize a grassroots movement in your area please check out the Capitol Hill Basics and the Grassroots Training Series on the AADE website.

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Tips for Communicating with Congress

The following are some helpful tips when communicating with your legislators about issues related to diabetes educators/education or other matters important to you.

Letters, Emails, and Faxes  

Personal letters are considered the most effective and persuasive way of communicating with elected officials, but email and faxes have become much more acceptable given the security concerns associated with traditional mail. Keep in mind that emails and faxes must be personalized to be effective. So when you receive action alerts from the AADE national office, and you have a few extra minutes, take the time to personalize those messages to your Members of Congress.

By E-Mail

E-mail is the most preferable way to contact Congressional Staff. Often, E-mail will get to staffers before a call.

House E-Mails

Formatted as FirstName.LastName@mail.house.gov  

Senate E-Mails

Formatted as FirstName_LastName@SenatorName.Senate.gov 

By Mail or Fax

  • Note: Because of security concerns, mail sent to Congressional offices is often delayed by several months. It is irradiated in transit, and may arrive blurred, burnt, or smeared. Reserve mail communications for the least time-sensitive issues

  • Keep it short. Limit your letter to one page and one issue.

  • Identify yourself and the issue. In the first paragraph of your letter state who you are, what issue you are writing about, and what action you want your legislator to take. Let your legislator know the size and mission of your group, if applicable. Use specific bill number(s) when possible.

  • Be clear and accurate. Focus on your main points. Choose the three strongest points to support your argument and develop them clearly. Use examples to support your position.

  • Make it personal. Tell your legislator why the issue matters to you and how it affects you, your organization (or family), and your community. Keep it local. Make a connection to the legislator.

  • Be courteous, yet firm.

  • Ask for a reply. Include your name and address on both your letter and envelope or email/fax.

  • Thank the legislator. Follow-up and thank elected officials when they vote the way you want. Writing to let them know you disapprove of the way s/he voted will gain attention also.

To write your Senator:

The Honorable (full name)
United States Senate
Washington, DC 20510

Dear Senator (last name):

To write your Representative:

The Honorable (full name)
US House of Representatives
Washington, DC 20515

Dear Representative (last name):

Note: When writing to the Chair of a Committee, it is proper to address them as: Dear Mr. Chairman or Madam Chairwoman:

By Phone

You can reach any Member of Congress by calling the Capitol Switchboard at (202) 224-3121 or the Members office directly. The fact that a legislator receives 20 or so calls on your issue just before a vote can make a difference.

When you reach the office, you will be answered by a receptionist. If you are a constituent of the Member (i.e. you live in their district) you are calling be sure to mention this first. Constituents get priority treatment. Ask to speak to whomever deals with the issue you are calling regarding. If the receptionist isn't sure who that may be - the Health Legislative Assistant is often the staff member who deals with issues related to diabetes education.

If you can't reach the aide who handles issues related to diabetes education, leave your message with the person who answered the phone. Be brief. Your message can be two sentences — one asking for support (or opposition); the other stating why. (You may want to write it out before you call.)

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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 credentialed diabetes educators, 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. Credentialed diabetes educators, 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 credentialed diabetes educators, 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 credentialed diabetes educators, 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 certified diabetes educators (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 credentialed diabetes educators, 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 credentialed diabetes educators ensures patient access.

Recommended Action
The American Association of Diabetes Educators strongly urges the immediate recognition of credentialed diabetes educators, 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. 1468 and H.R. 2787 to amend the Social Security Act, Title XVIII, to recognize credentialed diabetes educators, as Medicare providers for purposes of diabetes outpatient self-management training services.
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Advocacy Around the Nation!

In addition to the AADE legislative agenda the advocacy department monitors pertinent legislation that has some impact or relevance to the diabetes community as well as the service that diabetes educators provide.

States
Louisiana

Regulation LA 12656 2011: Department of Health and Hospitals/Office of the Secretary/Bureau of Health Services Financing

Diabetes Self-Management Training: Provides reimbursement to providers for rendering services that will educate and encourage Medicaid enrollees to obtain appropriate preventive and primary care in order to improve their overall health and quality of life. Amends the provisions governing federally qualified health centers (FQHCs) to provide Medicaid reimbursement for diabetes self-management training (DSMT) services.

Latest Action: 09/20/2011: Rule Adoption  Effective Date: 09/20/2011  Reg Source: Vol. 37, No. 9, Louisiana Register 09/20/2011 pp.2629-2630

Federal
  • H.R. 2960: A bill to amend the Public Health Service Act to foster more effective implementation and coordination of clinical care for people with pre-diabetes and diabetes.
  • Whitehouse Behavioral Tech bill S. 539
  • Fix HIT Act of 2011 S.643 and H.R. 1187

 

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Logan Nicole Gregory Honored with AADE’s 2011 Advocacy Award

The American Association of Diabetes Educators (AADE) announced the selection of Logan Nicole Gregory for its 2011 Advocacy Award. Gregory received the award in August at the association’s annual meeting in Las Vegas, Nevada. The award recognizes an AADE member, volunteer or other person that has made significant contributions to AADE advocacy and legislative efforts. The award was presented by Paul Madden (pictured below), chair of the AADE foundation board of directors.

Gregory was singled out for her contributions to the licensure of diabetes educators in the state of Kentucky, her commitment to advocate on behalf of people with diabetes at the state and federal level, and her support of diabetes educators and AADE’s advocacy mission.

“This extraordinary young woman tells her personal story in a way that all who hear her can understand the daily challenges she and her family face every day,” says AADE Chief Advocacy Officer Martha Rinker, JD. “She is able to succinctly illustrate how a qualified diabetes educator has helped give her family the information and coping skills needed to assist Logan in her life journey.”

Gregory, a 16 year old who has had diabetes for 14 years serves as an inspiration to other youth with diabetes, and adults to. “Diabetes is an obstacle, but it has taught me to take care of myself and to never let anyone or anything stand in my way,” she says.

 

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Be A Part of The AADE Social Network

Become a fan of AADE on FACEBOOK or follow us on TWITTER! 

  • AADE Facebook to network with your colleagues and connect with people from all over the country who have similar interests AADE 
  • 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

 

You can also 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

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Diabetes Advocacy Alliance Updates!

AADE continues its efforts with the Diabetes Advocacy Alliance to collaborate with the diabetes community to address issues that affect the millions living with diabetes.

Members of the DAA bring a variety of perspectives to addressing the many challenges that diabetes and prediabetes pose to the health of Americans and the US economy. They represent the points of view of patients, health care professionals, community-based nonprofit organizations, and corporations that provide life-enhancing products and services, all united by a desire to change the way diabetes and prediabetes are perceived, approached and treated.

The Diabetes Advocacy Alliance is a diverse group of organizations who have come together with the purpose of changing how we perceive and approach the problem of diabetes in this nation.

The vision of the Alliance is to influence change in the US health care system to improve diabetes prevention, detection and care and to speed the development of pathways to cures for diabetes.

The mission of the Alliance is to unite and align key diabetes stakeholders and the larger diabetes community around key diabetes-related policy and legislative efforts in order to elevate diabetes on the national agenda.

The DAA members are:

  • American Association of Clinical Endocrinologists (AACE)
  • American Association of Diabetes Educators (AADE)
  • American Clinical Laboratory Association (ACLA)
  • American Diabetes Association (ADA)
  • American Dietetic Association (ADA)
  • American Optometric Association (AOA)
  • Health Leadership Council (HLC)
  • Medicare Diabetes Screening Project (MDSP)
  • National Association of Chain Drug Stores (NACDS)
  • National Community Pharmacists Association (NCPA®)
  • National Kidney Foundation (NKF)
  • Novo Nordisk Inc.
  • Pediatric Endocrine Society
  • Results for Life
  • The Endocrine Society
  • VSP Vision Care
  • YMCA of the USA (Y-USA)

The alliance is growing and we encourage you to visit the website (below) to find out more about this initiative.

The DAA website: http://diabetesadvocacyalliance.org/

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