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The ADCES Advocacy Department has been actively engaged in advancing policies that support the work of the diabetes care and education specialist, improve health equity, reinforce the critical importance of diabetes education, and remove barriers that affect a person with diabetes from self-managing their diabetes. The following summary provides an overview of the main areas of focus for the Advocacy Department this quarter.

 Advancement of the Expanding Access to Diabetes Self-Management Training (DSMT) Act:

ADCES and our consultants from Baker Donelson have been working with the Diabetes Advocacy Alliance (DAA) to advance the Expanding Access to DSMT Act in the 117^th Congress. The Senate version of this legislation (S. 2203) was introduced on June 24. The House version of the legislation (H.R. 5804) was introduced on November 1. Below is a list of activities related to this effort:

• This quarter, ADCES, Baker Donelson, and the DAA met with the staff of the Democratic leads in the House (Rep. Kim Schrier D-WA) and Senate (Sen. Jeanee Shaheen D-NH) to discuss our strategy for advancing the bill. The group discussed the potential for the House Energy & Commerce and Senate Finance Committee to consider a chronic care/chronic disease package of bills. The DAA is working to put together a package comprised of diabetes, prediabetes, and obesity legislation that we can present to committee staff in the first quarter of 2022. We believe this approach will increase our chances of a hearing and/or mark-up of the legislation.

• The DAA will join the Obesity Care Action Network (OCAN) in hosting a briefing in January/February 2022 for a congressional caucus comprised of Republican doctors known as the “GOP Doc’s” Caucus. Kate Thomas will be presenting and discussing the DSMT bill.

• The ADCES Advocacy Committee continues to foster volunteer engagement to support advancement of this legislation through ongoing outreach to state coordinating bodies (CB) and state grassroots coordinators (SGC). The Committee has been championing a grassroots outreach network where each committee member serves as a regional “lead” charged with facilitating communication with states within their region. The regional leads have shared information about the legislation through this network and by cross-posting on state CB pages on ADCES Connect.

• The Advocacy Department worked with the Marketing and Communications Department on a communications strategy related to the November re-introduction of the House DSMT bill that included development of new informational materials including an infographic, press release, message in the monthly e-mail digest, member e-mail blast, Facebook Live session, social media postings, message distribution via ADCES Connect, media outreach, and more.

• Between the Advocacy Committee and marketing/communications efforts, ADCES saw a significant uptick in congressional letters sent via the legislative action center (over 1,000) in the last quarter of 2021.

Advocacy Activities Related to Telehealth Expansion:

• ADCES continues to urge Congress and CMS to ensure the temporary telehealth flexibilities permitted during the pandemic remain permanent. ADCES has a call to action and letter to Congress posted on our Legislative Action Center to encourage member engagement on this topic.
• ADCES has been tracking and advocating for telehealth legislation, including the CONNECT for Health Act (S. 1512). ADCES provided an update and a call to action to members during the annual reimbursement webinar which took place on December 7, 2021.

Federal Legislative and Regulatory Initiatives:

• National Clinical Care Commission (NCCC): The NCCC held their final meeting on September 8 and submitted their final report to Congress on September 30. View the final report here. The report includes recommendations around improving the DSMT benefit, addressing health disparities, diabetes prevention, and improving access to diabetes technology.  
• Part D Senior Savings Model (the Model): The Model is a Medicare Part D benefit that seeks to address medication cost barriers by offering beneficiaries a thirty-day supply of a wide-range of insulins for $35. ADCES worked with patient advocacy groups, including Beyond Type 1, and industry partners to address an enrollment issue beneficiaries might encounter during the Medicare open enrollment period (October 15 – December 7). ADCES also developed resources for diabetes care and education specialists to promote enrollment of eligible Medicare beneficiaries in this Model for 2022. These resources were shared via a blog post, social media, activity on the Advocacy Forum on ADCES Connect, and through the October 26 Advocacy Townhall meeting.
• PREVENT DIABETES Act: ADCES continues to support the PREVENT DIABETES Act. This legislation aims to strengthen the MDPP Expanded Model by allowing the participation of CDC-recognized virtual suppliers. ADCES has long advocated for the inclusion of virtual providers in the MDPP and has a call to action available on our Legislative Action Center to encourage DCESs to contact their legislators to support this important legislation. This legislation has been introduced in both the House and the Senate.
• CGM Measure Development: ADCES and Beyond Type 1 have been working with Abbott and Avalere Health, a healthcare consulting firm that develops quality measures, to serve as measure stewards in the development of quality measures around CGM devices. A technical expert panel was convened to draft measure concepts and these concepts were posted for public comment from December 17 – January 7. ADCES is working with Beyond Type 1 and Avalere Health to review the information obtained during the public comment period.
• Medicare Physician Fee Schedule (MPFS) Final Rule for 2022: The Centers for Medicare & Medicaid Services (CMS) published important changes to the medical nutrition therapy (MNT) regulations and Medicare Diabetes Prevention Program (MDPP) in the MPFS final rule for calendar year 2022. For the MDPP, these changes included waiving the supplier enrollment fee, changing the two-year services period to a one-year period to better align with the National DPP, and redistributing payments to account for the one-year services period. It is important to note that the MDPP changes were the direct result ADCES’ advocacy efforts through the DAA in urging the Center for Medicare and Medicaid Innovation (CMMI)/CMS to make changes. The DAA has been meeting with CMS/CMMI officials on a regular basis and commenting extensively on the challenges of the MDPP.
• Hepatitis B Foundation and Vaccination Recommendations: ADCES has developed a relationship with the Hepatitis B Foundation over the course of the past year and has tried to identify areas of alignment. The Hepatitis B Foundation presented during the April Advocacy Townhall meeting. In November, ADCES signed on to a letter to the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) urging support for a universal hepatitis B vaccination recommendation for adults. As a result of these advocacy efforts, the ACIP voted to recommend universal adult hepatitis B vaccination for all adults aged 19 – 59. The Foundation has also invited ADCES to nominate a representative to serve on an advisory panel they are convening to support the implementation of this recommendation.
• Drug Pricing: ADCES has been closely monitoring national drug pricing discussions, including the provisions included in the Build Back Better Act. ADCES has been coordinating with other organizations including the Endocrine Society and the Diabetes Leadership Council on related advocacy efforts. ADCES signed on to an ADA-generated letter to Senator Joe Manchin (D-WV) urging his support of a national insulin copay cap as part of the Build Back Better Act and any other vehicle.

2022 Public Policy Forum:

ADCES is closely monitoring COVID-19 activity throughout the country, as well as safety protocols and trends relative to in-person meetings and Hill days. Currently, there are safety/security protocols in place in the Capitol due to COVID-19 and following the events of January 6, 2021, that make in-person meetings challenging. The ADCES Advocacy Committee is reviewing the necessary information and will make a recommendation for the 2022 Public Policy Forum based on the most up-to-date information.

• The Advocacy Committee developed a 2021 grassroots outreach plan to engage CBs and state grassroots coordinators in advocacy. The Advocacy Committee identified an advocacy contact in each state. Each Committee member was assigned a region and is responsible for contacting advocates from the states within their region each month. The Advocacy Committee members have been engaging in regular contact with their regions and will focus on improving communications and outreach in 2022.
• Advocacy Committee members have been contributing content for an advocacy column in AIP on a quarterly basis and have identified the contributors for 2022.
• The Advocacy Committee hosted a virtual Advocacy Townhall meeting on October 26, 2021, with special guest, Dave Walton, CEO of the T1D Exchange. These townhalls continue to see robust participation with an average of 40-60 participants for each meeting. The Committee is reviewing the format, schedule, and speakers for 2022 and will finalize details in early February once the 2022 Advocacy Committee convenes.
• The Advocacy Committee submitted an abstract for ADCES22 focusing on the history of key policy changes and how advocates directly contributed to those changes.
• The Advocacy Committee reviews legislation, policies, position statements, and other requests and makes recommendations regarding ADCES support or endorsement. This quarter the Committee vetted sign-on letters and policies, including state legislation, to assess alignment with ADCES priorities and made recommendation regarding ADCES endorsement.

State:

• ADCES has been coordinating with state CBs and the ADA to advance insulin co-pay capping legislation in OH, MT, IA, GA, TX, FL, MI, MO and others.
• Advocates in MT have been conducting outreach to their congressional representatives and setting up meetings to discuss DSMT and telehealth legislation.
• ADCES continues to engage with the Helmsley Charitable Trust around their efforts to improve Medicaid coverage for CGM. Helmsley is convening a roundtable in early January to discuss Medicaid coverage for CGM, research conducted in this area, and opportunities and challenges related to this effort.

Practice Management, Coding, and Payment Committee Update:

• The Committee has been monitoring Medicare and commercial payer policies around telehealth and writing to payers to address issues when necessary.
• The Committee provides guidance on payment policy and has supported ADCES by editing and reviewing documents and letters, discussing policies, reviewing articles, and offering their clinical perspective in these discussions.
• The Committee is advising the Diabetes Technology Access Coalition (DTAC) in their efforts to make additional changes to the local coverage determination (LCD) for CGMs. A reconsideration request for the CGM LCD was submitted in September to the Medicare Administrative Contractors (MACs) with jurisdiction in this area, which has yielded a favorable response. We anticipate the MACs will open the LCD for comment in the coming year.
• The Committee is also reviewing DTAC’s policies and documents related to revising the Medicare national coverage determination (NCD) for insulin pumps.
• Additional committee members were added to the Committee for 2022 which will help to expand the knowledge base and reach of the Committee’s activities.

Member Engagement:

• Advocacy Townhall Meetings: The ADCES Advocacy Committee hosts quarterly advocacy townhall meetings. These meetings are open to all ADCES members to discuss advocacy.
• ADCES Connect: Staff uses this platform to disseminate advocacy updates to members on a regular, usually weekly, basis. Advocacy Committee members and other advocates have been sharing legislative updates.
• Communications: Staff continues to use ADCES platforms like social media, blog posts, AIP, and the Advocacy Forum to share advocacy information. We want to ensure that our advocacy efforts are being communicated through as many channels as possible.
• Public Policy Forum: Planning for the 2022 Public Policy Forum will focus on increasing member participation in advocacy and keeping up the momentum from our past virtual events which featured an increase in participation.
• Presentations: ADCES staff presented an advocacy update at the annual reimbursement webinar in December

Advocacy Outreach/Coalition Work:

As noted throughout this Advocacy Update, ADCES actively participates in several coalitions. ADCES contributes considerable staff and volunteer time to these coalition efforts with the goal of bringing the diabetes and larger healthcare communities together to advance shared advocacy goals, especially on the DAA.

• Diabetes Advocacy Alliance (DAA): Kate Thomas (staff) serves as co-chair of the DAA and is actively involved with the coalition’s activities:
• Staff and representatives from Baker Donelson participate in biweekly DAA conference calls and quarterly virtual meetings. ADCES/Baker Donelson lead the efforts of the DSMT workgroup and actively participate in the prevention, telehealth, health equity, and COVID-19 DAA workgroups.
• The DAA met with CMS Administrator Chiquita Brooks-LaSure in late September 2021 to discuss policy priorities. ADCES staff served as the primary contact and lead facilitator for this meeting.
• Christopher Holliday, the CDC’s new Director of the Division of Diabetes Translation, spoke to the DAA at their December 8 quarterly meeting and discussed the CDC’s priorities around diabetes and prediabetes.
• As previously noted, the DAA will meet with the Assistant Secretary of Health Admiral Rachel Levine, MD on January 27 to discuss the NCCC report.
• Technology Coalitions: ADCES participates in two new technology-focused coalitions, the Diabetes Technology Access Coalition (DTAC) and the ADA’s Technology Access Project (TAP).
• Staff participates in weekly DTAC meetings.
• The DTAC is working to make additional updates to the Medicare LCD for CGM devices and met with the MACs that oversee durable medical equipment (DME) on September 9.
• The DTAC submitted an LCD reconsideration request to the MACs in late September which received favorable feedback from the MACs.
• The DTAC is working to update the coverage criteria for insulin pumps and automated insulin delivery (AID) systems.
• Obesity Care Action Network (OCAN): Staff has begun to participate in regular monthly OCAN calls and will be presenting as a part of a OCAN/DAA panel for the GOP Doc’s Caucus.
• Staff participated in numerous webinars, weekly calls, and presentations held by the CDC, CMS, other federal agencies, and advocacy partners on topics addressing the Medicare open enrollment, the COVID-19 pandemic, DSMT, MDPP, and other important diabetes-related policies.
• This quarter, staff met with representatives from Novo Nordisk, Lilly, Insulet, Dexcom, Medtronic, Sanofi, T1D Exchange, Abbott, the Endocrine Society, Beyond Type 1, JDRF, Diabetes Volunteer Leadership Council, the National Kidney Foundation, the American Optometric Association, the College Diabetes Network, and others to discuss policies of mutual interest and opportunities for collaboration.
• Staff has a standing bimonthly conference call with the Helmsley Charitable Trust to discuss shared advocacy priorities.