During the 115th Congress, AADE worked with the Diabetes Advocacy Alliance to introduce legislation addressing some of barriers that Medicare beneficiaries with diabetes face when trying to access the diabetes self-management training (DSMT) benefit under Medicare. The Expanding Access to DSMT Act (H.R. 5768, S. 3366) was introduced in the U.S. House of Representative on May 10, 2018 by Representatives Tom Reed (R-NY) and Diana DeGette (D-CO). The companion legislation was introduced in the U.S. Senate in late August by Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME).
Though this legislation did not pass in the 115th Congress, AADE worked with the DAA to build solid congressional support for this legislation and has been working with our congressional champions to ensure the swift re-introduction of this legislation in the 116th Congress. We are hoping to reintroduce this legislation in the early spring. AADE encourages all of its members to contact your members of Congress, introduce yourselves, educate them on the role of the diabetes educators, and discuss this important legislation.
Why is this bill important?
As diabetes educators, we know that self-management can be a path to a better quality of life. However, barriers within the Medicare benefit keep some of our most vulnerable citizens from accessing DSMT. The Expanding Access to DSMT Act (H.R. 5768 and S. 3366) will reduce barriers and improve Medicare beneficiary access to DSMT services in the following ways:
- Allows the initial 10 hours of DSMT during the first year to remain available until fully utilized. If there's a determination of medical necessity, then an additional 6 hours of training/ education may be added.
- Allows 6 hours of DSMT in subsequent years, up from 2 hours.
- Removes the restriction related to coverage of DSMT and Medical Nutrition Therapy (MNT) services furnished on the same day.
- Excludes DSMT services from Part B cost-sharing and deductible requirements.
- Permits physicians and qualified non-physician practitioners who are not directly involved in managing an individual's diabetes to refer them for DSMT services. An example would be a specialist treating a comorbidity like gangrene or vision loss, or an emergency room doctor.
- Revises the Medicare Benefit Policy Manual to allow DSMT services to be furnished in a community-based location.
- Establishes a 2-year demonstration of virtual DSMT, potentially paving the way for future Medicare coverage of virtual DSMT services.
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