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AADE Advocacy Update

The AADE Advocacy Department has been actively engaged in advancing policies that support the work of the diabetes educator, reinforce the critical importance of diabetes education, and remove barriers that may 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 DSMT Act (H.R. 1840, S. 814)

• Bill Introduction: On March 21, Representatives Tom Reed (R-NY) and Diana DeGette (D-CO), along with 4 original cosponsors, introduced the Expanding Access to Diabetes Self-Management Training (DSMT) Act (H.R. 1840) in the U.S. House of Representatives. This is the House version of the legislation (S. 814) introduced by Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME) in the U.S. Senate on March 14. Tiffani Williams from Baker Donelson was instrumental in coordinating the introduction of this legislation with Senator Shaheen’s office

• Communication and Engagement: To inform our membership and engage our grassroots advocates, AADE communicated the introduction of the Senate and House bills through the following channels:
  • Social media posts including Facebook, Twitter, and LinkedIn
  • Member-wide e-mail blast
  • Creation of dedicated Expanding Access to DSMT bill webpage which includes a bill summary, issue brief, links to bill text, cosponsor lists, and engagement opportunities
  • Advocacy Forum post
  • Advocacy Blog Post on My AADE Network
  • Update to Board, CB leaders, and Advocacy Committee
  • Update planned for May FORWARD
  • Outreach to individual members with congressional connections
  • Promotion of this legislation at March 11 Children with Diabetes Capitol Hill briefing leading up to introduction
  • Advocacy Townhall meeting on March 26 to discuss the legislation
  • Engaged patient advocacy groups at Diabetes Patient Advocacy Coalition (DPAC) meeting April 3 and 4.
  • Outreach to press
  • Focus on legislation at 2019 Public Policy Forum

• Strategy for Advancement of Legislation: Now that the legislation has been introduced, AADE will work with our own members and other stakeholders to advance this legislation.
  • AADE is working with the Diabetes Advocacy Alliance to finalize a cost-savings analysis that demonstrates how removing barriers to DSMT can result in a financial savings to the Medicare program. This type of cost-savings analysis is useful when speaking to congressional offices, as many inquire about the cost of such legislation. The firm that conducted the analysis is scheduled to present at the AADE 2019 annual conference.
  • AADE will use the 2019 Public Policy Forum in Washington, DC to 1) broaden our reach with legislators and 2) provide attendees with a plan of action that they can implement in their home states once they return from the meeting.
  • AADE, through our consultants at Baker Donelson, continues to meet with congressional offices to increase the number of cosponsors on this legislation. AADE staff also works with Baker Donelson to initiate targeted grassroots outreach from our members.
  • Advocacy Committee will continue to foster volunteer engagement surrounding this legislation in the following ways:
    • Continue outreach to state CBs and State Grassroots Coordinators (SGCs).
    • Continue to host regular advocacy townhall conference calls to establish more engagement opportunities for AADE members. These calls are open to any interested AADE member.
    • Further develop our advocacy network through the Advocacy Forum on MyAADE Network. With these efforts, we hope to build a solid network of advocates to advance the bill.
    • Ensure regular communications with membership on the status of this legislation. Use platforms like social media, FORWARD, and AADE In Practice to encourage members to take action.
  • DAA member organizations are also working in coordination to advance the Expanding Access to DSMT Act. The ADA advocated for this legislation during their “Call to Congress.” The Diabetes Patient Advocacy Coalition (DPAC), the Endocrine Society, the American Optometric Association (AOA), and others have hosted legislative fly-ins where they have promoted this legislation.

 AADE 2019 Public Policy Forum: Planning is underway for the 2019 Public Policy Forum. This event is set to take place in Washington, DC May 19-21. Staff has been working to identify new ways to engage participants in this event and is coordinating with the Advocacy Committee on a productive agenda for this meeting.

Monitoring of Federal Legislation:

In addition to proactively advocating for the Expanding Access to DSMT bill this quarter, AADE also tracked other federal bills. Most notable include:

• Federal Spending Bills: AADE joined the DAA in sending a letter to leadership on the Senate and House Appropriations Committees asking them to support robust funding for the Centers for Disease Control and Prevention (CDC) including $185 million in dedicated funding for the Division of Diabetes Translation (DDT) and $30 million in funding for the National Diabetes Prevention Program (National DPP) at CDC. This letter was prompted over concerns with the President’s fiscal year (FY) 2020 budget that would reduce funding for the CDC and consolidate chronic disease funding. AADE also supported funding for the Special Diabetes Program (SDP).
• Drug Pricing: AADE is monitoring numerous proposals on Capitol Hill and within the Administration examining drug pricing and transparency. This quarter, the Senate Finance Committee held three hearings and the House Oversight Committee held two hearings. Other congressional committees are also reviewing drug pricing, including the House Energy and Commerce Oversight and Investigations Subcommittee. The Subcommittee held two hearings in early April. AADE staff worked with the Marketing and Communications Manager on a blog post about insulin pricing. Staff has been keeping members informed on congressional activities via the Advocacy Forum. Staff has also been working on a proposed revision to AADE’s position on insulin pricing so that the organization may respond quickly to proposed policy changes or discussions.

Regulatory Activities and Submission of Federal Comments:

• FDA Endocrinologic and Metabolic Drugs Advisory Committee review of Sotagliflizon: On January 17, the FDA Advisory Committee reviewed the new drug application for Sanofi/Lexicon’s SGLT-1/2 dual inhibitor sotagliflozin for type 1 diabetes. Stakeholders asked AADE to comment in support of this application; however, we determined that commenting on the safety, efficacy, or risks of a drug was outside of AADE’s scope and expertise. AADE sent a letter of support for innovation in new diabetes medications. The Advisory Committee ended up being split in their vote to approve the application. The FDA announced on March 22 that the application was not approved in its current form.
• Medicare Changes to Part D and Medicare Advantage Plans: As reported in January, AADE submitted comments on a Medicare proposed rule allowing Medicare Advantage Plans to use step therapy. The rule also discusses other provisions related to Part D medications, including formalizing the regulations related to the passage of the federal bills that banned gag clauses for pharmacies.
• Healthy People 2030: AADE engaged the Advocacy Committee and the Professional Practice Committee to review the proposed Healthy People 2030 objectives. AADE submitted comments in January addressing the proposed diabetes objectives. AADE also joined the DAA in joint comments. AADE shared this information in the March edition of
• CMS Request for Information on Accrediting Organizations and Consulting Arrangements: In December, CMS released a Request for Information (RFI) seeking public comment regarding the appropriateness of Medicare-approved Accrediting Organizations (AOs) providing fee-based consultative services to the Medicare providers and suppliers they accredit.  They are trying to determine if there are actual or perceived conflicts of interest between the AO’s accreditation and consultative entities. AADE submitted comments in response to this RFI.
• US Preventative Services Task Force (USPSTF) Draft Research Plan on Gestational Diabetes Mellitus: The USPSTF released the Draft Research Plan for Gestational Diabetes Mellitus: Screening. This plan was available for public comment. AADE engaged subject matter experts and submitted comments. AADE helped the DAA craft their comments and response.
• Clinical Laboratory Improvement Amendments (CLIA) Proficiency Testing Regulations: AADE responded to proposed CLIA changes that would relax the accuracy range for HbA1c in lab proficiency testing

Sign-on/Coalitions Letters: AADE joined many partner organizations in sign-on letters this quarter. These letters are available on AADE’s website. Below is a list of those letters.

• Letter to CMS on Medicare Diabetes Prevention Program (MDPP): As the expansion of the MDPP reaches its one-year anniversary, the DAA sent a letter to Administrator Verma suggesting program modifications to improve the accessibility and uptake of the MDPP benefit.
• Letter to Senate Health, Education, Labor, and Pensions (HELP) Committee: AADE joined the DAA in sending a letter to the Senate HELP Committee on how the 116^th Congress can address America’s rising healthcare costs.
• Letter to House of Representatives in support of the Special Diabetes Program (SDP): AADE joined a group of organizations in asking members of Congress to support funding for the SDP.
• Community Statement on Medicare coverage of medically necessary dental therapies: AADE signed on as a supporter of a community statement urging policy makers to cover medically necessary dental therapies. The statement discusses the impact of untreated oral microbial infections on individuals with chronic diseases, and how preventing or delaying medically-necessary dental treatment can impact other medical treatments like organ transplants, cancer therapies, heart surgery, etc

State Activities:

• AADE joined a group of advocacy organizations in sending a memo to state legislators in New York. This memo expressed support for the provision in Governor Cuomo’s budget that includes state Medicaid coverage for the National DPP.
• The California Coordinating Body (CB) has been working to reintroduce and advance a bill that would expand Medicaid coverage for continuous glucose monitors (CGM). They introduced legislation in the Assembly in late February. The Assembly Health Committee held a hearing on March 26 to review the legislation, which passed out of committee. In advance of the hearing, AADE sent an action alert to all CA AADE members to contact their state assembly members.
• The Arizona CB coordinated with ADA on legislation that would expand coverage for DSMES in the state. The AADE national office facilitated this interaction.
• To assist in tracking state activities, the Advocacy Committee and staff have encouraged advocates to share advocacy stories on this Advocacy Forum on MyAADE Network. This quarter, members from TX and KY shared updates on the Advocacy Forum. Members from KY, NY, PA, VA, MO, IN, and CO shared updates on the March 26 Advocacy Townhall call.
• Staff is seeking state monitoring platforms to better track state level legislation and proactively inform state CBs when issues arise.
• AADE has identified Medicaid coverage for CGM as another critical state issue for 2019. Staff has been coordinating with staff from the Helmsley Charitable Trust and T1D Exchange to collect data on current state coverage requirements for CGM to better inform our advocacy strategy going forward. We hope to produce an updated tracking document for Medicaid coverage of CGM.

Member Engagement:

• My AADE Network: Staff has been working with the Advocacy Committee to improve member engagement, specifically regarding advancing the Expanding Access to DSMT bill. The Advocacy Department has been focused on more frequent communications to members on advocacy activities and using the Advocacy Forum on My AADE Network to engage members on advocacy issues. The Advocacy Department is working to build an advocacy network in the following two ways:

• Increase subscribers to the Advocacy Forum on My AADE Network
• Increase content and communications on this site.

Staff has also been working with Advocacy Committee members to post content on the discussion forum on a weekly basis, and staff posted four in-depth blog posts this quarter. Topics addressed emergency prescription refill laws, a quarter update of AADE’s advocacy activities, and a summary of recent Hill activities.

• Identification of State Grassroots Coordinators: Advocacy staff is working with the Advocacy Committee and the state CBs to ensure that each state identifies a state grassroots coordinator (SGC) to serve as the conduit for advocacy information between the AADE national office and the state CB. Staff has sent multiple communications to CB leaders asking them to identify their SGCs.

• Advocacy Townhall Meetings: The AADE Advocacy Committee hosted two townhall meetings this quarter (1/23 and 3/26). These meetings are open to all AADE members and are meant to connect diabetes educators who are active advocates or interested in learning more about advocacy. We have received a positive response to this type of engagement opportunity and hope to continue hosting these events throughout the year.

• Advocacy Website: The advocacy section of AADE’s website has a new look! The Advocacy Department worked with the Marketing and Communications Department to update and revise this section of the website, including adding a page dedicated to the DSMT bill. A main priority was simplifying the information and providing more advocacy engagement opportunities.

• Launch of Non-Medical Switching Toolkit: The Advocacy department worked with the Corporate Development department to launch the “Empowering People with Diabetes: Addressing Non-Medical Switching” toolkit. This toolkit, sponsored by Janssen Pharmaceuticals, Inc., contains resources including tip sheets, infographics, advocacy information, and other documents that diabetes educators can use to help educate and empower people with diabetes to stay on their prescribed medications when faced with non-medical switching.

• Communications: Advocacy staff continues to use AADE platforms like social media, FORWARD, blog posts, 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.

Stakeholder Meetings:

AADE monitored and/or participated in key meetings this quarter. These include coalition meetings and governmental meetings:

• Staff monitored (via webcast) the January 17, 2019 meeting of the FDA Endocrinologic and Metabolic Drugs Advisory Committee. The Advisory Committee discussed the new drug application for sotagliflozin, sponsored by Sanofi.
• Staff participated in the National Clinical Care Commission virtual meeting on February 20. The next meeting is scheduled for June 27 in Bethesda, MD.
• AADE joined their DAA colleagues in a call with Ann Albright from the CDC to address the findings of a report commissioned by the DAA to look at gaps in private payer coverage of the National DPP.
• Staff has been monitoring congressional hearings on drug pricing.
• AADE continues to actively engage with the Health Equity Collaborative. Leslie Kolb co-chairs the Strategic Design Workgroup. Leslie attended and presented at the CMS Quality Conference in late January, where the Health Equity Collaborative met face to face.
• AADE staff Leslie Kolb and Kate Thomas attended a meeting (by phone) with other DAA staff members at CMS on February 25 to discuss the agency’s regulatory authority in addressing barriers to DSMT.
• Staff and representatives from Baker Donelson attended the March 6 DAA quarterly in-person meeting in Washington, DC. AADE continues to participate in biweekly DAA calls and is active in the DAA prevention workgroup.
• On March 6, AADE joined the DAA in hosting a reception for current and prospective members of the Congressional Diabetes Caucus
• On March 11, AADE participated in a Capitol Hill briefing examining the “State of Diabetes.” Children with Diabetes hosted this briefing, and AADE Advocacy Chair Kathy Gold, CDE, MSN, RN participated as a member of an advocacy panel that helped address questions from the briefing attendees.
• AADE staff participated in the STOP Obesity Alliance Membership Meeting on March 26.
• Staff participated in a call on March 27 discussing the HHS Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Healthy People Objectives for 2030
• AADE President Karen Kemmis and Immediate Past President Donna Ryan attended ADA’s Call to Congress legislative fly-in on March 27-29.
• AADE staff attended the DPAC Community Advocacy Policy Summit on April 3 and