Covid-19 and social distancing measures have really changed the landscape of DSMES across the country. To keep up with these changes, the Centers for Medicare & Medicaid Services (CMS) has loosened or changed many of their requirements. This has been a complex process that involves Congress/CMS/the Trump Administration and others working together to execute these changes.
The challenge is that DSMT is unique in terms of CMS reimbursement and there don’t seem to be any services that align. What’s even harder is how diverse our programs are – which really should be our greatest strength in terms of reach and access – from FQHCs, RHCs, pharmacies, physician groups, private practices, community settings and more. But because all of these entities follow different processes for billing and reimbursement, it does get complicated.
Here’s a quick summary of the COVID-19 changes until this emergency is over and what ADCES is advocating for:
- Allowing DSMT to be provided on a one-on-one basis.
- Allowing DSMT to be provided audio only.
- Early on, we advocated for removing the geographic and originating site requirements so services could be provided in the individual and provider’s homes.
- Addressing UB-04 billing issue.
- Advocating for DSMT to be provided by any provider in all settings, FQHCs, RHCs, HOPD.
- Waiving in-person requirements for CGM and insulin pumps.
- Not enforcing the clinical indications for CGM.