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