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New Medicare Bill to Provide Long Needed Overhaul of Diabetes Treatment Services

Mar 18, 2019

On March 14, Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME) introduced the Expanding Access to Diabetes Self-Management Training (DSMT) Act (S. 814) in the U.S. Senate. And on March 21, Representatives Tom Reed (R-NY) and Diana DeGette (D-CO) introduced the companion bill into the House of Representatives (H.R 1840). The bill addresses major barriers to access for Medicare beneficiaries, creating more flexibility on when and where DSMT services can be accessed, as well as reducing the overall cost burden.

“We know that self-management is a path to better quality of life and improved outcomes, yet barriers within the Medicare benefit keep some of our most vulnerable citizens from accessing DSMT services,” said Karen Kemmis, AADE president. “AADE is proud to have helped introduce this important piece of legislation along with the Diabetes Advocacy Alliance and our Senate champions. Now it’s critical that we encourage every legislator to support this non-partisan, common sense bill.”

Expanding access to this critical benefit will result in an even greater cost savings to Medicare, while improving beneficiaries' quality of life. Individuals who receive DSMT services save the Medicare program an estimated $135 per month. DSMT can delay the onset of serious diabetes complications including kidney disease, heart disease, amputations, and vision loss from diabetes-related retinopathy. These complications ultimately impact the quality of life for those with diabetes and contribute to rising healthcare costs. Despite the proven benefits of DSMT, only 5 percent of beneficiaries access it. This legislation makes necessary changes to the DSMT benefit to ensure that more eligible beneficiaries can participate in DSMT.

If passed, the Expanding Access to DSMT Act would:

  • Permit physicians and qualified non-physician practitioners who are not directly involved in managing an individual's diabetes to refer them for DSMT services.
  • Allow the initial 10 hours of DSMT during the first year to remain available until used and allow 6 additional hours of DSMT services during the year in which the initial 10 hours are used.
  • Allow 6 additional hours of DSMT each year after the initial 10 hours are used.
  • Allow DSMT and Medical Nutrition Therapy (MNT) services to be provided on the same day.
  • Exclude DSMT services from Part B cost-sharing and deductible requirements.
  • Revise the Medicare Benefit Policy Manual to allow DSMT services to be provided in a community-based location.
  • Establish a 2-year demonstration of virtual DSMT, potentially paving the way for future Medicare coverage of virtual DSMT services.

The U.S. House of Representatives is expected to introduce their version of the bill later this week.

The Expanding Access to DSMT Act was originally introduced to the 115th Congress in May, 2018 (Senate) and August, 2018 (House of Representatives) but did not gain enough support to pass. Since then, AADE has worked with partners like the Diabetes Advocacy Alliance to consolidate congressional support for a swift reintroduction in the 116th Congress.

AADE is encouraging the public to contact their legislator to support the Expanding Access to DSMT Act. For more information visit DiabetesEducator.org/advocacy.

About AADE
AADE is a multi-disciplinary professional membership organization dedicated to improving diabetes care through innovative education, management and support. With more than 14,000 professional members including nurses, dietitians, pharmacists, exercise specialists, and others, AADE has a vast network of practitioners working with people who have, are affected by or are at risk for diabetes. Learn more at www.diabeteseducator.org, or visit us on Facebook (American Association of Diabetes Educators), Twitter (@AADEdiabetes) and Instagram (@AADEdiabetes).

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