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ADCES Advocacy Update

The ADCES Advocacy Department has been actively engaged in advancing policies that support the work of the diabetes care and education specialist, 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.

Expanding Access to Diabetes Self-Management Training (DSMT) Act (H.R. 1840, S. 814): In March 2019, this legislation was introduced by Representatives Tom Reed (R-NY) and Diana DeGette (D-CO) in the U.S. House of Representatives and by Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME) in the U.S. Senate.

• ADCES and its coalition partners have been successful in adding cosponsors to the bill; however, we are looking to add more Republican cosponsors to offset the large number of Democratic cosponsors that have been recently added.
  • ADCES staff initiated a call to action to the 2019 Public Policy Forum attendees and subscribers of the Advocacy Forum who previously met with or may have had contact with key Republican offices. ADCES advocates responded immediately to this call to action and contacted every designated office. Specifically, Public Policy Forum attendees lead the effort, demonstrating their ongoing commitment to advocacy beyond just involvement in the Forum.
  • On November 6 and November 12, members of the DAA conducted Hill meetings with eight Republican members of Congress that sit on key committees. Baker Donelson represented ADCES at these meetings. This, combined with the grassroots efforts of ADCES members, led to Vern Buchanan (R-FL) and George Holding (R-NC) signing on as cosponsors of H.R. 1840. ADCES advocates in NC were persistent in their follow-up and Rep. Holding’s staff notified our NC advocates directly to inform them of his cosponsorship.
• Members of the DAA, including ADCES, also met with staff from the House Ways and Means and Energy and Commerce Committees to discuss the status of the bill. Committee staff advised the DAA that a formal committee hearing would be an important next step in advancing the bill. The DAA is working with committee staff and our congressional champions to identify timing for a hearing.
• ADCES, the DAA, and our congressional champions are still awaiting a directional score from the Congressional Budget Office (CBO). This score was requested in mid-September by Senator Shaheen. A directional score will give an estimate of whether this legislation will result in a cost or savings to the system. This information is necessary to advance and pass this legislation. For example, if the legislation is determined to provide a savings, legislators may want to use the savings to offset the costs of other bills. Baker Donelson facilitated the communications with Senator Shaheen’s office that led to this scoring request. Due to the heavy demand for CBO scores, the scoring process will take some time, but it is in motion.
• The Diabetes Patient Advocacy Coalition (DPAC) conducted Hill meetings on November 12 and included the DSMT bill as one of their legislation priorities. ADCES supported this Hill day by providing information and materials on the DSMT bill.
• ADCES Advocacy Committee continues to foster volunteer engagement to support advancement of this legislation in the following ways:
  • Ongoing outreach to state coordinating bodies (CB) and state grassroots coordinators (SGCs), including follow-up with state advocates who attended the 2019 Public Policy Forum.
  • Hosting regular advocacy townhall conference calls to establish more engagement opportunities for ADCES members. These calls are open to any interested ADCES member. The committee held a townhall meeting on November 5.
  • Developing an advocacy network through the Advocacy Forum on My AADE Network and sharing information, like blog posts, via this network.
  • Using platforms like podcasts, social media, FORWARD, AIP, and the Volunteer Leader Newsletter to update members and encourage them to take action.

 Federal Legislative and Regulatory Initiatives:

• Agency for Healthcare Research and Quality (AHRQ): The Advocacy and Science and Practice Departments collaborated to respond to the AHRQ’s call for nominations for a new evidence report examining the role of diabetes care and education specialists in decreasing therapeutic inertia. AHRQ’s call for nominations was specifically for their Evidence-based Practice Center (EPC) Program. AHRQ will use these ideas to determine the focus of its evidence reports for the upcoming year. ADCES staff participated in a conference call with AHRQ staff in December to answer questions regarding our proposal. AHRQ will make a final decision on EPC nominations in February 2020.
• National Clinical Care Commission (NCCC): The NCCC met in-person on November 22. ADCES provided extensive comments to the NCCC outlining the challenges that diabetes care and education specialists face and how policy improvements, specifically within the Medicare program, could reshape how care is delivered. The DAA also submitted comments outlining current barriers to care and sharing policy recommendations. ADCES staff participated in a call with members of the NCCC’s Treatment and Complications Subcommittee. The Subcommittee is reaching out to non-governmental stakeholders to collect information, and staff anticipates that additional requests for data will be forthcoming.
• Prevention X: The U.S. Department of Health and Human Services (HHS) issued a Request for Information (RFI) on effective prevention strategies to address chronic diseases, including prediabetes and type 2 diabetes. ADCES addressed the questions posed in the RFI and submitted a formal response to HHS. The DAA also submitted comments.
• Special Diabetes Program (SDP): ADCES joined other organizations in urging members of Congress in both the House and Senate to endorse the reauthorization of the SDP before funding expired on December 20, 2019. The reauthorization of the SDP would ensure the continuation of important type 1 diabetes research and prevention and treatment programs for at-risk populations. In December,
• Cures 2.0: Representatives Diana DeGette (D-CO) and Fred Upton (R-MI) put out a request for comments on their proposal for “Cures 2.0,” an initiative to expand upon the progress made as part of the 21^st Century Cures Act. The request for comments focused on how to improve coverage for digital health technologies and access to lifesaving cures. ADCES submitted comments. ADCES also joined our the DAA and the Diabetes Technology Coalition in submitting coalition comments.
• House Ways & Means Committee Rural and Underserved Communities Health Task Force: ADCES joined the DAA in a letter to the House Ways and Means Committee Rural and Underserved Communities Health Task Force responding to an RFI on ways to improve health care outcomes within underserved communities.

State:

• Staff presented on the topic of diabetes advocacy at the October California CB meeting. As part of this meeting, the California CB hosted a legislative day at the state capitol for their members. Staff was able to participate in this legislative day, which received positive feedback from both attendees and legislative staff. Based on the success of this state capitol day, the Advocacy Committee is preparing an informational document to assist other states in scheduling similar events.
• ADCES staff provided recommendations to the New York State CB about holding a state capitol day in Albany. This further supports the need for documentation to assist states with planning these legislative days.
• The Massachusetts CB partnered with ADA champions in the state to host a Word Diabetes Day event at the MA state house.

Medicare and Payment Advocacy:

• Medicare Physician Fee Schedule Proposed Rule: ADCES closely reviewed the Medicare Physician Fee Schedule final payment rule for 2020. There were no items of significant interest or concern for ADCES. ADCES also developed and disseminated an analysis of the provisions contained in the rule to members.
• Medicare Coverage of Virtual DPP:
  • Senate Letter: Senators Tim Scott (R-SC) and Mark Warner (D-VA) led a bipartisan letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma, urging them to make CDC-recognized virtual Diabetes Prevention Program (DPP) providers eligible for reimbursement in the Medicare Diabetes Prevention Program (MDPP) expanded model. ADCES worked with the DAA on the development of this letter and in building the list of senators supporting this letter. Representatives from Baker Donelson joined the DAA in conducting Senate meetings regarding this letter.
  • Center for Medicare and Medicaid Innovation (CMMI) Meeting: Members of the DAA, including ADCES, met with representatives from the CMMI to discuss virtual coverage and access for the MDPP. The DAA has been having regularly (approximately every 6 months) meetings with CMMI staff.
• New Diabetes Technology Coalition: ADCES joined a new diabetes technology coalition convened by the ADA. This coalition will address coverage challenges related to diabetes technology. This coalition meets biweekly.
• Medicare CGM: ADCES joined Abbott, JDRF, AACE, ADA, and the Endocrine Society in a letter to CMS requesting the removal of the Medicare coverage restriction that limits access to therapeutic continuous glucose monitoring (CGM) systems to beneficiaries who have been performing frequent (four or more times a day) self-testing with a blood glucose monitor (BGM). This problematic requirement has hindered access to CGM for Medicare beneficiaries.

ADCES 2020 Public Policy Forum: Planning is underway for the 2020 Public Policy Forum. This event is set to take place in Washington, DC May 17-19. Staff has been working to identify new ways to engage participants in this event and is coordinating with the Advocacy Committee to create a productive agenda for this meeting. The Advocacy Committee discussed how best to engage sponsors, what materials should be provided to supplement the experience, how to connect people within regions and states, and how best to debrief and follow-up after the event. The 2020 Public Policy Forum announcement has been posted to the Advocacy Forum on My AADE Network, in FORWARD, during the Advocacy Townhall meeting, on ADCES’ website, and via our legislative podcast. Staff will also provide information at the Leadership Forum in January.

Advocacy Committee Engagement:

• Members of the Advocacy Committee reviewed and vetted a request by Senator Schatz (D-HI) to sign on as an original endorsing organization of the CONNECT for Health Act of 2019. This legislation proposes to remove some of the barriers to using telehealth services, including establishing a model to look at expanding the list of telehealth providers to include:  nurse practitioners, physical, speech, or occupational therapists, physical or occupational therapy assistants, registered professional nurses, licensed practical nurses, or licensed certified social workers, registered respiratory therapists, or certified respiratory therapy technicians. ADCES previously endorsed this legislation, though the language has changed since the last time the bill was introduced in 2017. There are now provisions that address natural disasters and emergency departments.
• The Advocacy Committee is in the process of developing a resource document to support states in planning advocacy days at their respective state capitols. This provides an opportunity to utilize the expertise and experience of Advocacy Committee members in how to plan these advocacy events.
• The Advocacy Committee provided feedback in response to a request from the new diabetes technology coalition to assess the specific coverage issues that people with diabetes face in accessing diabetes technology. They solicited feedback from colleagues to better understand existing coverage challenges related to diabetes technology. Staff was able to share this information with the coalition.
• The Advocacy Committee analyzed and reviewed the Preventing Diabetes in Medicare Act and the Diabetic Vision Loss and Blindness Prevention Act and made recommendations regarding ADCES’s endorsement of these pieces of legislation.
• The Advocacy Committee has begun to focus on planning of the 2020 Public Policy Forum and plans to assist with recruiting representatives from different states to attend and how to structure the program.
• Ann Constance published a blog post on My AADE Network discussing an advocacy summit convened in Michigan’s Upper Peninsula.

Practice Management, Coding and Payment Committee Update:

• The Practice Management, Coding, and Payment Committee has been meeting monthly since October.
• The Committee developed a framework to review the coding and payment landscape. Committee members are researching and documenting current issues, existing resources, and payment policies.
• Committee members will use this framework to inform committee priorities and future activities.

Member Engagement

• Advocacy Townhall Meetings: The ADCES Advocacy Committee hosted a townhall meeting on November 5. These meetings are open to all ADCES members and are meant to connect diabetes care and educations specialists who are active advocates or interested in learning more about advocacy.
• Communications: Advocacy staff continues to use ADCES platforms like social media, FORWARD, blog posts, AIP, the Advocacy Forum, and the Volunteer Leaders newsletter to share advocacy information. We want to ensure that our advocacy efforts are being communicated through as many channels as possible.
• Podcasts: ADCES continues to record advocacy-focused podcasts. In mid-November, ADCES released a legislative update providing information on recent happenings on Capitol Hill including drug pricing legislation and the Expanding Access to DSMT bill.
• Webinar: ADCES staff provided an advocacy update during Patty Telgener’s annual Reimbursement Update webinar. The goal was to tie current reimbursement issues and information to ADCES’s advocacy efforts and how the organization is working to improve payment and reimbursement.

Stakeholder Meetings and Advocacy Outreach:

• Staff and representatives from Baker Donelson attended the December 4 DAA quarterly in-person meeting in Washington, DC. ADCES continues to participate in biweekly DAA calls and is active in the DAA prevention and DSMT workgroups.
• Staff participates in monthly coalition calls with the STOP Obesity Alliance, Health Innovation Alliance, the Partnership to Protect Patient Health, and the Diabetes Technology Coalition.
• Staff met with representatives from the National Minority Quality Forum to discuss their new data index and future partnership opportunities.
• Staff monitored (via webcast) the November 13 FDA Endocrinologic and Metabolic Drugs Advisory Committee meeting. The FDA Committee reviewed BI/Lilly’s submission of a supplemental New Drug Application (NDA) to propose the use of empagliflozin (Jardiance) as an adjunct treatment to insulin therapy to improve glycemic control in adults with type 1 diabetes. The FDA Committee voted 14-2 not to approve this NDA with general agreement that larger, longer-term studies to better assess DKA risk with the treatment.