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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 care and education specialist, 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.

• At AADE’s annual conference, staff co-represented with a representative from IHS Markit, the firm that Diabetes Advocacy Alliance (DAA) worked with to conduct a cost-savings analysis of the DSMT bill. This analysis was conducted to provide a cost estimate to congressional offices as we await a formal Congressional Budget Office (CBO) score. This information was made available to those that attended the 2019 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.
• In mid-September, Senators Sherrod Brown (D-OH) and Debbie Stabenow (D-MI), joined Senator Jeanne Shaheen in requesting a directional score from the CBO for the Expanding Access to DSMT bill. This 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 costs that appear in 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 is likely to take some time, but it is in motion.
• AADE did an August Recess “call to action” and requested that AADE members meet with their members of Congress during the August district work period. Staff received positive feedback that individuals met with or reached out to their congressional representatives. Individuals attended local events in Texas, engaged in outreach in Texas, and initiated grassroots in Kentucky, just to name a few examples. Approximately 11 cosponsors were added to the House bill as a result of these August recess advocacy efforts. This call to action was promoted on the advocacy podcast, through the Advocacy Forum on My AADE Network, on AADE’s website, at the AADE 19 convention in Houston, and via social media.
• AADE 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. AADE’s consultant from Baker Donelson, Tiffani Williams, developed a Republican target list. This list was shared with the DAA so that the group could target these offices. AADE also engaged the 2019 Public Policy Forum attendees and other advocates who may have contact with those offices. AADE did another “call to action” in September. States that responded to this call to action included Missouri, North Carolina, Washington, Pennsylvania, Massachusetts, Utah. Florida, Texas, and Georgia. Many of the advocates who have contacted congressional offices attended the Public Policy Forum.
• AADE, through our consultants at Baker Donelson, continues to meet with congressional offices to increase the number of cosponsors on this legislation.
• The DAA is planning a series of Hill meetings on Wednesday, November 6 to kick-off November is Diabetes Awareness Month. AADE will supplement these activities with grassroots action alerts.
• AADE has also coordinated with the Diabetes Patient Advocacy Coalition (DPAC) in providing content and information for two recent (September, November) Hill days that they have hosted.
• 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). The Advocacy Committee had a table at the CB COI Reception at the annual conference to discuss the DSMT bill and promote the new Legislative Action Center.
  • Hosting regular advocacy townhall conference calls to establish more engagement opportunities for AADE members. These calls are open to any interested AADE member. The next townhall meeting is scheduled for November 5.
  • 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, AIP, and the Volunteer Leader Newsletter to encourage members to take action.

Federal Legislative and Regulatory Initiatives:

• AADE staff engaged experts from the Professional Practice Committee to draft and submit comments in response to the proposed definition of “health literacy” for Healthy People 2030. Those comments were shared on AADE’s website and via FORWARD. AADE also continues to participate in Healthy People 2030 webinars and meetings as they continue to define their objectives and goals.
• AADE signed on to a letter with other organizations of the Diabetes Policy Collaborative (DPC) urging health plans to adopt IRS Notice 2019-5, which increases the types of medical care that can be designated as “preventive” for patients with chronic illnesses such as diabetes, arthritis or hypertension. This allows people with high-deductible health plans (HDHPs) linked to health savings accounts (HSAs) to receive coverage for those treatments even if their overall spending has not reached their plan’s deductible limit. This information was shared on AADE’s website, FORWARD, and AADE in Practice.
• AADE joined a number of other organizations in urging members of Congress in both the House and Senate to endorse the reauthorization of the Special Diabetes Program (SDP) before funding expired on September 30, 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. Congress passed a continuing resolution to fund the SDP and the government through November 21 and we are awaiting a more permanent funding fix.
• AADE continues to work with the DAA to advocate for increased funding for the CDC National Diabetes Prevention Program (DPP). In mid-September, the Senate Committee on Appropriations released their FY2020 subcommittee recommendation for the LHHS appropriations bill and provided an additional $2 million to the CDC National DPP (up to $27.3 million) and included report language for increased flexibility in serving low-income populations.
• National Clinical Care Commission (NCCC): AADE joined the DAA in submitting comments in advance of the September 27 NCCC virtual meeting. AADE took the lead in identifying and preparing the DAA coalition priorities for the NCCC. During the September meeting, the NCCC focused on their data collection efforts. They NCCC planned to collect data from federal agencies, but it was also suggested that they reach out to the DAA and specifically AADE to collect additional information. The next NCCC meeting will be held on November 22.

Medicare and Payment Advocacy:

• Medicare Physician Fee Schedule Proposed Rule: AADE provided comments to CMS in response to the Medicare Physician Fee Schedule (MPFS) proposed rule for calendar year 2020. There were no items of significant interest or concern for AADE. AADE shared these comments with AADE members through My AADE Network and the September FORWARD newsletter. AADE also developed and disseminated an analysis of the provisions contained in the rule to members. CMS is expected to release the MPFS final rule in early November. AADE will communicate with members upon the release of this rule. AADE also joined the DAA in a sign-on letter in response to the proposed rule.
• Medicare Coverage of Virtual DPP: AADE has been working with the DAA in a Senate letter to the US Department of Health and Human Services advocating for CDC-recognized virtual DPP providers to be eligible for reimbursement in the MDPP expanded model. This has involved extensive outreach to Senate offices.
• Coverage for Glucagon Delivery Methods: AADE joined other organizations in a letter to payers asking them to cover all glucagon delivery methods. This letter was coordinated by Xeris Pharmaceuticals.
• Practice Management, Coding, and Payment Committee: AADE staff worked with AADE leadership to identify committee members. This committee held their first meeting on October 10.
• Application for New Accrediting Organization for DSMT: AADE responded to a notice from CMS that The Compliance Team applied to become a national accrediting organization (AO) for DSMT. AADE’s comments were centered around ensuring parity with the other AOs, e.g. each AO should follow the National Standards for DSMES.

State:

• AADE coordinated with the CA CB to join a coalition sign-on letter advocating for Medi-Cal coverage of the Omnipod Insulin Management System.
• AADE coordinated with the NY State CB to send a letter to the NY governor requesting that he veto legislation that would change driver’s license restrictions for people who have experienced an episode of unconsciousness. The legislative proposal would be detrimental for people with diabetes, who have experienced an episode of unconsciousness, but whom are approved to drive by the health care provider.
• AADE sent action alerts to its members in CA urging them to contact their legislators and the CA governor’s office regarding AB 848, legislation that would expand Medi-Cal coverage to include continuous glucose monitors (CGM). This legislation ultimately passed the CA Senate in late August. Unfortunately, the CA Governor vetoed this bill. Advocates in CA are regrouping and determining next steps in the face of this news.
• AADE staff presented at the CA CB meeting on October 17. As part of this meeting, the CA CB coordinated a visit to the state capitol in Sacramento. Staff was able to participate in this successful event.
• Advocates from the IA CB were invited to participate in a roundtable hosted by Rep. Cynthia Axne. This roundtable was focused on the high cost of health care including surprise medical bills, drug pricing, and other access issues.
• AADE has also identified Medicaid coverage for CGM as another critical state issue for 2020. AADE’s summer pharmacy intern conducted research on the current state laws and regulations surrounding Medicaid coverage for CGM. Staff continues to meet quarterly with the Helmsley Charitable Trust to continue the research in this area and build upon current advocacy efforts.

Member Engagement:

• Advocacy Townhall Meetings: The AADE Advocacy Committee hosted a townhall meeting on November 5. 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.
• New Legislative Action Center: AADE launched a new Legislative Action Center platform, which features both grassroots engagement tools and legislative tracking. This new system went live on August 1. AADE staff offered a blog post and in person demonstration at AADE’s annual conference that highlighted the new features of the site. Information about the new tool was also shared via an advocacy podcast, through the Advocacy Forum on My AADE Network, on AADE’s website, social media, and through the FORWARD e-newsletter.
• Communications: Advocacy staff continues to use AADE 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: On July 29, AADE staff recorded an advocacy-focused podcast featuring guest Sheila Burke from Baker Donelson. Sheila provided a current snapshot of what is happening on Capitol Hill, an update on the Expanding Access to DSMT bill, and ways for AADE members to engage with their legislators during the August congressional recess. The Advocacy Department also recorded another advocacy podcast with CA advocate Suzanne Lohnes, which was released in early October.
• Public Policy Forum: Planning is underway for the 2020 Public Policy Forum. This event is tentatively set to take place in Washington, DC on May 17-19. Staff has been working to finalize the details and begin promoting the event.

Advocacy Committee Engagement

• The Advocacy Committee provided feedback to the CDC on questions related to self-monitoring of blood glucose (SMBG). The responses to the questions were used to prepare the CDC for a meeting their agency director had scheduled with the Center for Medicare and Medicaid Innovation.
• Members of AADE’s Advocacy Committee conducted individualized outreach to Public Policy Forum attendees in late July. The goal was to asses attendee’s progress on their action plans and to provide a point of contact for advocacy related questions.
• The Advocacy Committee provided feedback in response to a request to join the Partnership to Protect Patient Health.
• The Advocacy Committee meets monthly to discuss pertinent advocacy issues.

Stakeholder Meetings and Advocacy Outreach:

• Staff and representatives from Baker Donelson attended the September 11 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.
• Staff participates in monthly coalition calls with the STOP Obesity Alliance.
• Staff continues to engage with the Health Innovation Alliance on matters related to Health IT.
• Staff continues to engage with the NCCC and plans to submit formal comments in advance of their next meeting.
• Staff had an introductory call with the American Council of the Blind to discuss areas of shared interest.
• Staff had an introductory call with the Partnership to Protect Patient Health. This coalition, part of Alliance for Patient Access, is looking at drug-injury advertisements and the impact these advertisements have on those with chronic diseases.
• Staff was contacted by a representative from Prevent Blindness. This organization was interested in our new Legislative Action Center and information around how we incorporate this into our advocacy strategy.