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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): 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.

• Strategy for Advancement of Legislation: AADE has been working with our own members, consultants, and other stakeholders to advance this legislation.
  • AADE worked with the Diabetes Advocacy Alliance (DAA) 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 (in the absence of a formal “score”), 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. The DAA also has a one-pager on the cost-savings analysis that can be shared with congressional offices. This information was made available to those that attended the 2018 Public Policy Forum. The cost-savings analysis suggests that with the passage of the legislation, annual Medicare spending on beneficiaries with diabetes would be reduced by a total of about $9.4 billion over the next ten years. This equates to an average savings of $1,276 per year per Medicare beneficiary.
  • An important next step in advancing the Expanding Access to DSMT Act is to request that the Congressional Budget Office (CBO) review and provide a formal score for this legislation. A score tells members of Congress if the legislation will result in a cost or savings to the system. They may also determine that the legislation is budget neutral. This information is a key piece in passing the legislation. For example, if the legislation is determined to provide a savings, legislators may want to use the savings to offset costs that appear in other bills. The analysis conducted by the DAA was meant to provide an assessment of how CBO may score the legislation.
  • 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.
  • AADE’s Advocacy Committee continues to foster volunteer engagement surrounding this legislation in the following ways:
    • Ongoing outreach to state CBs and State Grassroots Coordinators (SGCs).
    • Hosting regular advocacy townhall conference calls to establish more engagement opportunities for AADE members. These calls are open to any interested AADE member. The last townhall was held on June 19.
    • Developing an advocacy network through the Advocacy Forum on My AADE Network.
    • Ensuring regular communications with membership on the status of this legislation. Use platforms like social media, FORWARD, and the Volunteer Leader Newsletter to encourage members to take action. Recently, the Marketing and Communications Department recommended that AADE In Practice add a regular advocacy column to further our reach with members. The first article will appear in the September issue and will be devoted to the Expanding Access to DSMT bill.
  • DAA member organizations are also working in coordination to advance the Expanding Access to DSMT Act.
    • This quarter, the DAA through the strategic guidance of Baker Donelson, met with members of the Congressional Black Caucus, the Congressional Hispanic Caucus, and the Congressional Asian Pacific American Caucus to advance the Expanding Access to DSMT bill.
    • On May 2, the Diabetes Patient Advocacy Coalition (DPAC) hosted a Hill day and a congressional briefing addressing the pressing issues impacting Americans with diabetes. The Expanding Access to DSMT bill was one of the areas highlighted.
    • On May 15, CEO Chuck Macfarlane served as panelist for a congressional briefing hosted by the Lion’s Club International on the Expanding Access to DSMT bill. The Lion’s Club also hosted a legislative fly-in for their members.
    • On May 20 and 21, AADE members participated in the 2019 Public Policy Forum. There were 35 states represented. Individuals visited over 120 congressional offices and made many important connections on Capitol Hill. Public Policy Forum attendees continue to engage in outreach to their congressional representatives, which has resulted in more than doubling the number of cosponsors on both the House and Senate bills. Most of the new cosponsors can be directly attributed to AADE meetings.
    • In July, the Academy of Nutrition and Dietetics (AND) hosted a legislative fly-in for 400 of their members. They advocated for Expanding Access to DSMT bill.
  • NCBDE did a call to action for the Expanding Access to DSMT bill through their Facebook page in early July.

AADE Public Policy Forum: As mentioned above, AADE hosted its annual Public Policy Forum on May 20 and 21 in Washington, DC.  Much of AADE staff time this quarter was focused on planning, executing, and following up from this event.

• Event Recap: We had over 35 states represented and 63 attendees, which allowed us to meet with about 120 congressional offices. AADE’s primary focus for the 2019 Public Policy Forum was building support for the Expanding Access to DSMT Act (H.R. 1840, S. 814). Attendees spent the first day of the event reviewing the legislation and preparing for meetings with legislators. On the second day, attendees visited Capitol Hill to meet with their legislators to discuss the legislation. AADE is excited to report that following our Hill day, we saw an increase in support for this legislation. Senators Stabenow (MI) and Coons (DE) and Representatives Watkins (KS), Delgado (NY) and Axne (IA), among others, added their names as cosponsors shortly after our meetings. As of mid-July, we had over 35 cosponsors on the House bill and 7 on the Senate bill. Staff submitted a detailed Program Evaluation for review by the Board of Directors.
• Next Steps: Our goal for this event was not just to meet with legislators, but also to empower attendees to take action and engage their colleagues throughout the year. Staff is pleased to report that attendees have continued their congressional outreach following the event. They contacted their legislators following their Hill meetings. They have written blogs posts and encouraged other diabetes educators to contact their congressional representatives. Since the event, we have seen over 400 letters sent via AADE’s Legislative Action Center. Members of AADE’s Advocacy Committee are planning to reach out to each attendee in mid-July to check-in on how attendees are progressing on their action plans. We also hope to connect with attendees while in Houston for AADE 2019.
• Public Policy Forum 2020: AADE is already looking ahead at scheduling the Public Policy Forum in DC for 2020. Staff plans to engage in outreach to the CBs early to increase participation in the 2020 Forum and build upon the momentum of 2019.

 Regulatory Activities and Submission of Federal Comments:

• Healthy People 2020: On June 20, AADE joined the DAA in co-hosting a webinar with the Office of Disease Prevention and Health Promotion (ODPHP) on the sustainability of diabetes prevention and self-management programs. ODPHP and DAA have a partnership designed to promote Healthy People 2020 objectives related to diabetes. Leslie Kolb presented an update on the work of the Health Equity Collaborative. AADE staff members participated in the webinar to learn more about this topic.
• Health People 2030:
• On June 26, AADE staff participated in a webinar hosted by the HHS Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030. AADE has been actively involved in communicating to the Secretary on the development and implementation of Healthy People 2030 objectives.
• AADE plans to submit comments regarding the proposed definition of “health literacy” for Healthy People 2030. Members of the Professional Practice Committee assisted in the review of this proposed definition.
• CMS Advocacy:
• On April 16, CMS held a National Care Transitions Awareness Day. This event was designed to increase awareness and action in the beneficiary and provider communities of the importance of safe and effective care transitions between all care settings. Advocacy Committee member Lisa Laird and staff participated virtually. Click here to learn more and access resources on care transitions.
• In May, AADE joined other stakeholders within the diabetes community in a letter to CMS Administrator Seema Verma about modifications that could be made within the Medicare program to improve diabetes care. The requests outlined in this letter include revising coding for innovative technology and updating local and national coverage decisions to reflect current clinical standards and best practices, thus eliminating unnecessary barriers to care.
• On May 28, members of the DAA, including AADE, met with representatives from the Center for Medicare and Medicaid Innovation (CMMI) to discuss virtual coverage and access for the Medicare Diabetes Prevention Program (MDPP).
• On June 3, AADE leadership (2018 President Donna Ryan) and staff (CEO Chuck Macfarlane, Chief Science and Practice Officer Leslie Kolb, and Director of Advocacy Kate Thomas) met with representatives from the Centers for Medicare & Medicaid Services’ (CMS) Quality, Safety & Oversight Group under the Division of Acute Care. The Quality, Safety, & Oversight group oversees Medicare’s Diabetes Self-Management Training (DSMT) Accreditation Program. As a CMS-approved accrediting organization (AO) for DSMT programs, it is critical for AADE to continue to work and foster relationships with the Quality, Safety, & Oversight group at CMS. AADE has regular communication with this group, which allows us to keep our members and accredited programs up to date with the most current information from the Agency. This in-person meeting provided an additional opportunity for AADE leadership to meet with CMS officials and discuss AADE’s Vision for the Specialty and other strategic items.
• In June, AADE joined other stakeholders in sending a white paper to CMS Administrator Verma as a follow-up to the letter sent in May. This white paper provides a more detailed discussion of the issues related to improving access to technology for Medicare beneficiaries.
• AADE Advocacy Committee member Lisa Ranes was appointed by CMS to serve as part of a MACRA Episode-Based Cost Measure Clinical Subcommittees (CS) to develop an episode-based cost measure for diabetes.
• Nominations: AADE pursued nominations of diabetes educators for appointments to a committee within the National Quality Forum (NQF), the US Preventative Services Task Force (USPSTF), and the MACRA CS (as referenced above).
• National Clinical Care Commission: On June 27, the National Clinical Care Commission (NCCC) held an in-person meeting. This meeting included a report from the different subcommittees operating within the NCCC. The DAA submitted comments regarding addressing gaps and improvements that can be made within the current system regarding Medicare DPP, DSMT, and coverage of technology by Medicare. At this meeting, the NCCC reported on the work they conducted in their subcommittees regarding prevention and diabetes complications and treatment.
• Letter on Prescription Drug Rebates: AADE submitted a letter to the Secretary of the US Department of Health and Human Services (HHS) and the Inspector General responding favorably to the HHS proposed rule that would eliminate prescription drug rebates from federally funded health plans like Medicare and Medicaid managed care plans.
• CPT Application for DPP Code: AADE took the lead in working with the YMCA and the AMA to submit a Current Procedural Terminology (CPT) code change application to the CPT Editorial Panel requesting that the current Category III Code for the National (DPP) be transitioned to a Category I code.

State Activities:

• The California Coordinating Body (CB) has been working to reintroduce and advance a bill that would expand Medicaid coverage for continuous glucose monitors (CGM). AADE sent out a series of action alerts to CA members urging them to contact their state legislators regarding this important legislation.
• AADE, with the support of the CT Coordinating Body, signed on to a letter of support for CT Governor Lamont’s proposal to include National DPP Medicaid coverage in his state budget. A member of the CT CB hand-delivered this letter to the Governor at a meeting which they both attended.
• AADE worked with the ADA and the MA CB to send a letter of support for legislation that would allow trained school staff to administer glucagon in the case of an emergency.
• AADE worked with the ADA and the CA CB to send a letter of support for “Breakfast after the Bell” legislation which authorizes funding for school breakfast programs to be offered after the school day starts.
• On June 12, AADE staff participated in a meeting to explore how to make the National Diabetes Prevention Program (DPP) a covered Medicaid benefit for eligible adults with prediabetes in Illinois. This meeting was put together by the Illinois Public Health Institute in partnership with the Illinois Department of Public Health, the Illinois Department of Healthcare and Family Services, and the Chicago Department of Public Health.
• 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:

• Advocacy Townhall Meetings: The AADE Advocacy Committee hosted a townhall meeting on June 19. 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 regarding this type of engagement opportunity and hope to continue hosting these events throughout the year. This townhall was attended by many Public Policy Forum attendees who provided updates on their advocacy outreach.
• Advocacy Website/Legislative Action Center: AADE staff is also in the process of finding a new software vendor for our Legislative Action Center platform. We are looking at a platform that has more functionality for AADE members. We anticipate launching this new site by August 1, 2019.
• 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. New for this quarter- staff recorded an advocacy podcast and there are plans underway for future advocacy podcasts. The Advocacy Department will also have a regular column in AIP.

Stakeholder Meetings and Advocacy Outreach:

• AADE took the lead with the American Association of Clinical Endocrinologists (AACE) on a provider letter to UnitedHealthcare addressing their coverage policy for insulin pumps. JDRF circulated this sign-on letter. Endocrine Today featured an article on the advocacy efforts surrounding this issue.
• On May 16, Nancy D’Hondt, AADE President 2017, served as a panelist at a cardiovascular health policy summit entitled “Breaking Point: Cardiovascular Disease in America.”
• Staff and representatives from Baker Donelson attended the June 6 DAA quarterly in-person meeting in Washington, DC. AADE continues to participate in biweekly DAA calls and is active in the DAA prevention and DSMT workgroups.
• On June 13, AADE staff participated in the STOP Obesity Alliance Membership Meeting.
• On June 13, AADE staff presented at a Women in Government Relations meeting hosted in Chicago. This was at the invitation of AstraZeneca. Attendees included state and local legislators.
• On July 17, AADE staff attended a conference on non-medical switching in Washington, DC. This conference was hosted by Janssen Pharmaceuticals, Inc. AADE has been working closely with Janssen on non-medical switching, most recently preparing a toolkit for AADE members.