Diabetes education bill stirs controversy

There are differences of opinions regarding a recently introduced diabetes education Medicare bill.

The Access to Quality Diabetes Education Act of 2015 (H.R. 1726 and S.1345), introduced by Rep. Ed Whitfield (R-Ky.) and Sen. Jeanne Shaheen (D-N.H.), is described as “a bill to amend title XVIII of the Social Security Act to improve access to diabetes self-management training by authorizing certified diabetes educators to provide diabetes self-management training services, including as part of telehealth services, under part B of the Medicare program.”

The Diabetes Miseducation Coalition, a coalition of groups representing health coaches, nutrition specialists, and wellness experts, is opposing the Act, saying it limits access to care because the proposed restrictions outlined in the legislation could effectively cut the number of qualified diabetes educators for Medicare beneficiaries in half. The American Association of Diabetes Educators (AADE) supports the Act and has responded by saying that it will do just the opposite: increase access and quality of care.

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“The purpose of the coalition is to prevent the control of diabetes education by a single self-interested certification organization at the expense of people with diabetes,” says coalition member Darrell Rogers, director of the International Association of Health Coaches. “We support policies that promote diversity in approaches, practitioners, and methods to assist the estimated 29.1 million people with diabetes and pre-diabetes.”

The Act does not in any way limit those who can give care to diabetes patients, and does not impact those who currently administer Diabetes Self-Management Training (DSMT) but in fact enlarges the pool of those who can be reimbursed for offering DSMT, according to Kurt Anderson, director of Federal and State Advocacy, AADE.

“The Act is a common sense response to the underutilization of DSMT, and would merely serve to increase quality and access to DSMT care, not ‘cut providers in half’ which would run contrary to the intent of this extremely bipartisan, non-controversial bill,” Anderson says.

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Diabetes is on its way to becoming the fastest growing and most costly chronic disease. “Low-cost, innovative interventions and lifestyle coaching provided by diverse practitioners are policies that should be encouraged,” Rogers says. “Forfeiting all aspects of ‘diabetes education’ to a single organization that seeks to make its private credential required by state law is protectionist and anti-science.”  

According to Anderson, the Act allows a broader group of individuals to receive provider codes so that they can be recognized by Medicare for providing DSMT to patients in need.

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“Currently, there are a myriad of individuals who can bill Medicare for DSMT,” he says. “The DSMT statute notes that ‘providers’ include physicians or other Medicare providers. In practice, this typically includes physician assistants, advance practice nurses, and pharmacists, among others. The bill simply adds a technical clarification to the effect that ‘Certified Diabetes Educators’ would be included within this group of providers. No existing DSMT provider would be removed from the statute. Put another way, no one is ‘mandated’ to become a CDE to provide DSMT services.

“While AADE does have members in many of these classifications, we do not, by any means represent all of these individuals.  AADE does not own or administer the CDE credential,” Anderson continues. “No existing provider of DSMT services would be ‘forced’ to ‘pay’ to become a CDE. The Act only enlarges the number of individuals who will be reimbursed by Medicare for providing DSMT.”

Rogers encourages healthcare executives to seek out the innovators in health and wellness “that work with individuals and shift them from being passive recipients of expensive healthcare interventions to adopting a responsible, self-directed, proactive stance that facilitates lasting positive change. We want to keep preventative healthcare avenues open, competitive and striving for success,” he says.