News & Publications

The New Expanding Access to Diabetes Self-Management Training Act

May 29, 2018

By: Leslie Kolb RN, BSN, MBA,
AADE Chief Science and Practice Officer

Leslie KolbAADE is excited to announce a new bill that could help millions under Medicare affected by diabetes. HR 5768, the “Expanding Access to Diabetes Self-Management Training Act,” was recently introduced to the House of Representatives by Tom Reed (R-NY) and Diana DeGette (D-CO). This is a huge step to reduce the barriers to diabetes education as well as increase the potential for real impact. 

Right now every voice is needed to get this bill passed! Click here to let your rep know you support HR 5768. If you’re on Twitter, send them a tweet sharing your support for the bill and be sure to mention that you are in their district. CSPAN has a fantastic list of representatives’ Twitter handles

Only 5% of Medicare beneficiaries with newly diagnosed diabetes use DSMT services. 

AADE together with the Diabetes Advocacy Alliance (DAA) organizations helped shape the language of the bill to improve access to Diabetes Self-Management Training (DSMT) services and increase the number of hours allowed under Medicare. DSMT has been a covered benefit under Medicare for more than 20 years but it has unfortunately been drastically underused. 

Despite the undisputed benefits of DSMT for people with diabetes — lower hemoglobin A1C, weight loss, improved quality of life, healthy coping skills and reduced healthcare costs — only 5% of Medicare beneficiaries with newly diagnosed diabetes use DSMT services. 

The legislation amends title XVIII of the Social Security Act to expand access to DSMT services under the Medicare program. This section of the bill would do the following:
  • Expand access to DSMT services by permitting physicians and qualified nonphysician practitioners who are not managing an individual’s diabetes, but who are acting in coordination with the physician or qualified nonphysician practitioner managing the individual’s diabetes to order DSMT services.
  • Extend the initial 10 hours of DSMT covered by Medicare beyond the first year until fully utilized. Furthermore, allow an additional 6 hours (or greater if determined appropriate by the Secretary) of DSMT services during the year in which the initial 10 hours are exhausted, if there is a determination of medical necessity.
  • Allow 6 additional hours (or a greater number if determined appropriate by the Secretary) of DSMT services per year, each year, after the year in which the initial 10 hours are used, if there is a determination of medical necessity. 
  • Allow additional hours to be permitted if there is a determination of medical necessity.
  • Remove the restriction relating to coverage of DSMT and Medical Nutrition Therapy services furnished on the same day.
  • Remove Part B cost-sharing for DSMT services and exclude DSMT from the deductible requirements.
  • Revise the Medicare Benefit Policy Manual to allow DSMT services to be furnished by a hospital outpatient department at a nonhospital site, such as a community-based location.

So what’s next? HR 5768 has been introduced in the House of Representatives and referred to the Energy & Commerce and Ways & Means committees. Committee members will “mark up” the bill, offering changes before voting on it. The bill must then pass through both of these committees before coming to a vote before the full House of Representatives.

The DAA is also working on introducing a companion bill in the Senate. The Senate companion to HR 5768 will follow a similar path of committee work before coming to the full senate for a vote. Once this bill is introduced, AADE will ask members to contact their local senator to support this bill. 

If the House and Senate do not pass identical versions of the bill, it will “go to conference,” a process in which the disparities of both bills are reconciled. This final reconciled bill must then go for a vote before both the House and Senate before going to the President for signature. The President’s signature will turn the bill into law. 

Stay tuned for updates from AADE and the DAA as we share next steps with you. Together, we can impact legislation that truly changes lives.


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  1. Jun 21, 2018

    I am so glad there are a number of people commenting on the disturbing fact that Medicare does not recognize RN, CDE's as people capable of billing them for DSME/T services.  I passed the same CDE exam as my co-worker (a RDN) and yet everything I document is signed off and billed by her.  I believed AADE was going to champion for change on this issue?!  This would go a long way in creating more access to diabetes education services.  I feel equally qualified to independently bill for this service under my own NPI number.  Let's make this a higher priority please.
  2. Jun 03, 2018

    I agree with many of the comments. As a patient becoming an expert with DSM self management takes more than 10 hours. RN, CDEs and RD, CDEs are equalling qualified to empower patients with DSM self management skills. These professionals both sgould be billing for DSME services. Nancy, RN, ACNS-BC, CDE
  3. Jun 02, 2018

    I agree with the comments above. If the legislature is serious about providing services to the growing community of those diagnosed with DM, allow RNs to bill for DSME. RDs and RNs should be able to work in collaboration to the top of their skills. The current system sets up an unnecessary disparity that hinders professional development and patient care. Please advocate strongly for this advancement!

    Shannon Hale, RN, BSN, CDE

  4. Jun 02, 2018

    I agree completely with both the above comments. 

    As an RN, CDE my goal is to help patients with diabetes learn to live healthy with diabetes.  Lack of Primary Care Physicians

    making referrals,  Medicare's limited amount of time for patient education and the nightmare of getting reimbursed makes it

    difficult for DSME/S to function at an optimal level.  Patients are hungry for information; we are aware that today's 12 minute

    office visit with the PCP does not allow time for questions to get answered.

    Diana E. Jones RN BSN CDE

  5. Jun 02, 2018

    Let's first work to obtain full reimbursement to all CDE's providing DSME.  We have to pass the CDE exam  which covers all aspects of DSME, including nutrition, yet an RD can obtain reimbursement for a DSME class without ever having taken an exam consisting of all other aspects of DSME which are crucial to the diabetic's health.

    This would make more opportunities for patients to attend comprehensive DSME classes where the educators would be able to bill independently within recognized programs.

    I do agree to your idea of medicare covering a longer time period to use their 10 hour benefit.

  6. May 31, 2018

    Should this bill pass, it will certainly increase access to DSMES and be a great boon to our patients! 

    Yet, another potential for increasing access to DSMES is to secure the ability of RN, CDEs to be 'preferred providers' for CMS.  If our DSMES service loses its accreditation/recognition, at least the RN, CDE could continue to provide DSMES.  

    As an RN, CDE working in rural DSMES for 20 years, I have personally experienced and am concerned re: program closures in the face of increasing rates of diabetes/pre-diabetes. Without going through the rigors/expense of getting & maintaining accreditation AND being unable to bill for DSMES, I wonder how many RN, CDEs have been displaced and left the DSMES field?  

    I agree with AADE's desire for CDEs to 'widen their circle' when it comes to the services we provide (ie care management, etc.)  But in rural areas where DSMES services are scarce, it is sad that RN, CDEs cannot continue to provide this much-needed service simply because their facilities cannot afford to keep the service going.  RN, CDEs who have been a part of getting programs accredited/recognized have demonstrated the depth of their expertise--can't we keep these experts 'in play?' 

    Vicki Berg, RN, CDE

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