On May 10th, Reps. Reed and DeGette introduced the “Expanding Access to Diabetes Self-Management Training Act” (H.R. 5768) to Congress. The Senate followed with S. 6633, introduced by Senators Shaheen and Collins, on August 22nd. These bills would provide avenues for people with diabetes to receive more diabetes self-management training (DSMT) through Medicare, and change the way DSMT is delivered.
What is diabetes self-management training?
DSMT is a program covered by Medicare Part B designed to teach beneficiaries how to manage their diabetes. The training covers healthy eating, being active, monitoring one’s blood sugar, taking necessary medication, and reducing risks. The training is delivered by a doctor or qualified trained medical professional, and involves both individual and group sessions. Currently, Medicare covers 10 hours of DSMT per beneficiary, including 1 hour of individual training and 9 hours of group training. A beneficiary may also quality for up to 2 hours of follow-up training each year if it takes place in a calendar year after the year they got their initial training. In order to get DSMT covered by Medicare, the beneficiary must have a written order from their doctor.
What does H.R. 5768 & S. 6633 change?
The bills would drastically increase Medicare beneficiaries’ access to DSMT services.
- Referrals: The bills would permit physicians and qualified non-physician practitioners who are not directly involved in managing an individual’s diabetes to refer them for DSMT services.
- Hours: The bills would also allow the initial 10 hours of training during the first year to remain available until used up, and would allow 6 more hours of DSMT during the first year. After the first 10 hours are used, the bill would allow for 6 additional hours of DSMT each year.
- Nutrition: The bills would also remove a current restriction that prevents DSMT from being delivered at the same time as Medical Nutrition Therapy. It makes sense to talk about diabetes and food at the same time!
- Cost: The bills would exclude DSMT services from Part B cost-sharing and deductible requirements.
- Community: The bills would change the Medicare Benefit Policy Manual to allow DSMT services to be provided in a community-based location instead of only medical offices.
- Innovation: The bills would establish a 2-year demonstration of virtual DSMT, which could lead to Medicare coverage of virtual DSMT in the future.
These bills are a giant step forward in delivering DSMT to people who need it. The bills need cosponsors! Write to your representative and senators and ask them to support people with diabetes and cosponsor H.R. 5768 and S. 6633!