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CMS Rules Continue to Explore the Expansion of Medicare Coverage for Diabetes Education and Prevention

Nov 03, 2016

The American Association of Diabetes Educators (AADE) is pleased to see Medicare’s continued focus on ensuring the National Diabetes Prevention Program (National DPP) will be a reimbursable benefit starting January 2018, in accordance with the final 2017 Physician Fee Schedule released by the Centers for Medicare and Medicaid Services (CMS).

AADE is one of six organizations in a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to scale the National DPP nationwide and the only one to offer prevention education within Medicare-certified diabetes self-management education programs. The AADE Diabetes Prevention Program (AADE DPP) model is a proven success for participants. A recently published study of the original 25 AADE DPP programs revealed an average weight loss of more than 5%, and a current average weight loss of more than 6%.   

AADE submitted comments in September 2016 advocating for CMS rulings on Diabetes Prevention and Diabetes Self-Management Training (DSMT). Of the more than 6,000 comments submitted, more than 1,100 referenced AADE issues of interest.

“We are pleased to have made significant contributions toward this advance in making the diabetes epidemic more manageable,” said Joanna Craver DiBenedetto, director of prevention at AADE, “CMS is recognizing the reality that for many people, diabetes can be prevented through education, awareness of risk factors and lifestyle management. This move will benefit public health and save money.”

In the DPP section of this final rule, there were many responses to address specific comments submitted by AADE. This confirms that CMS plans to cover the National DPP as a Medicare benefit as of January 2018. In this ruling, Medicare also stated they will begin Medicare Diabetes Prevention Program supplier enrollment for those programs eligible before the expansion becomes effective, but not until after the next round rule-making is completed in 2017. AADE is currently preparing services to assist programs through the process of CDC Recognition and DPP implementation as well as CMS application to become a MDPP supplier in 2017.

CMS did not address our concerns on changes to the diabetes self-management training (DSMT) benefit. AADE has long advocated for increased access to DSMT through self-referral, the elimination of copays and deductibles, increased reimbursement and the addition of more DSMT hours when warranted. CMS did acknowledge it would take many of the comments received under consideration. AADE will continue conversations with CMS to reduce these barriers and hopes to see movement in the near future. 

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