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In July, we emailed you about new developments in the 2017 Physician Fee Schedule, which contains both issues related to the low utilization of DSMT and the proposed rule for the Diabetes Prevention Program (DPP). We have carefully crafted our comments on both developments to best represent diabetes educators and the patients you serve. We welcome you to join us in submitting your own comments. For more information on how to do so, please click here.
In short, we are recommending that the following barriers to DSMT be addressed:
- Eliminate patient out of pocket expenses, such as copayment and deductible for DSMT
- Increase Medicare payment for G0108 and G0109
- Allow eligibility for additional DSMT hours when change in medical condition warrants additional education (i.e. similar to MNT)
- Adhere to ADA and AACE guidelines and include A1C as one of the criteria for diagnosing diabetes
- Allow hospital accredited DSMT programs to provide DSMT in off-site locations
- Expand providers who can refer for DSMT
We are also recommending that the following be considered to ensure a successful Medicare Diabetes Prevention Program (MDPP) implementation:
- Increase the number of high quality MDPP Suppliers
- Modify MDPP reimbursement structure
- Enhance program delivery with quality assurance and fraud avoidance- staff requirements
- Increase outreach to potential and current DPP participants with diagnosed diabetes
- Modify MDPP session duration guidance
To read AADE’s full comments, click here. For more information on CMS, please visit diabeteseducator.org/cms.
All comments must be submitted through the CMS portal by 5:00 PM ET on September 6, 2016.
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