Final Rule for the Physician Fee Schedule Released

Includes Responses on Diabetes Prevention and DSMT

Improving Payment Accuracy for Services: Diabetes Self-Management Training (DSMT)

CMS did not address our concerns relative to changes to the diabetes self-management training (DSMT) benefit. While this was not the optimal result we had hoped for, we are encouraged that CMS wants to continue to examine barriers to DSMT and will continue to do so in 2017. We have long advocated for increased access to DSMT through self-referral, increased reimbursement, the elimination of copays and deductibles and the addition of more DSMT hours when warranted. We will continue conversations with CMS to reduce these barriers and hope to see movement in the near future. We will let you know how you can remain involved in this important fight to remove the barriers to DSMT. 


Final DSMT Ruling:

​ Medicare Expansion of Diabetes Prevention Program (DPP) Model

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. There were many responses to address the specific comments we submitted. We now know 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 MDPP 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 an MDPP Supplier in 2017.

Final DPP Ruling:

In July, 2016 interested stakeholders were invited to express their thoughts, comments, and concerns to CMS during an open comment period ending on September 6, 2016. CMS will reviewed all comments received and prepared a ‘final rule’ as seen above. 

AADE's full comments:

Medicare Expansion of DPP Model - Timeline

  • Proposed 2017 Physician Fee Schedule- Released July 7, 2016
  • Comment Period for Proposed PFS- Comments due to CMS by September 6, 2016
  • Release of Final Physician Fee Schedule and CMS response to comments- November 2016
  • Availability of Programs to apply to be a Medicare DPP Supplier- 2017 (TBD)
  • Proposed 2018 Physician Fee Schedule- Release July 2017
  • Final 2018 Physician Fee Schedule- November 2017
  • Coverage of DPP for Medicare Population- January 1, 2018 (could change based on final rule)