Medicare News
| For Immediate Release: | Contact: |
| Thursday, December 28, 2000 | CMS Office of Public Affairs 202-690-6145 |
For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov. |
|
MEDICARE ANNOUNCES EXPANDED COVERAGE OF TRAINING FOR BENEFICIARIES IN SELF-MANAGING DIABETES
The Health Care Financing Administration today announced the final rule for expanded Medicare coverage enabling beneficiaries with diabetes to get training from qualified providers in self-managing their disease.
Under the regulation, to be published tomorrow in the Federal Register, any provider who is already eligible to bill Medicare, and who meets quality standards for this benefit, can provide the training for Medicare beneficiaries eligible for the service. The regulation will take effect 60 days after publication in the Federal Register.
To qualify for this training, a beneficiary must be either newly diagnosed with diabetes, or did not receive training at the time of diagnosis, or is at significant risk for complications from the disease.
"Teaching Medicare beneficiaries with diabetes about managing their disease will allow them to live longer and lead more productive lives," Acting Deputy HCFA Administrator Robert Berenson said. "The expanded coverage also will save taxpayers money by helping reduce the number of doctor visits and medical procedures needed to treat the serious complications that may result from the disease."
Currently, 819 diabetes self-management training programs across the country already meet quality standards set by the final rule. HCFA expects other programs will also become available as they meet the final rule's requirements. Beneficiaries can contact their local Medicare carrier for information about the existing programs.
Medicare beneficiaries with diabetes will initially receive one hour of individual training or assessment and nine hours of group training. The regulation also allows two hours of annual follow-up training that can be given on an individual basis. For beneficiaries with special needs such as reduced vision or hearing, physicians will be able to order individual training for all sessions.
Beneficiaries will be trained by a team that includes, at a minimum, a certified diabetic educator (or a registered nurse with training as a diabetic educator) and a registered dietitian. The training will provide information on diabetes and important topics for diabetic patients, including diet, exercise, medication, behavior modification, as well as prevention, detection and treatment of acute and chronic diabetic complications.
Diabetes is highly prevalent among elderly Medicare beneficiaries. National data has indicated it is the seventh leading cause of death in the United States. Numerous clinical studies point to the necessity of maintaining good control of the disease to reduce the risk of diabetic complications and diabetes-related hospitalization.
"Diabetes has reached epidemic proportions in different segments of the Medicare population, particularly among Native Americans, African-Americans, and Hispanics," said Dr. Jeff Kang, HCFA Chief Clinical Officer. "We hope that wider access to diabetes self-management training will enhance the quality of life of all Medicare beneficiaries by reducing the severity and number of complications that many diabetics experience."
A 1997 General Accounting Office report concluded that Medicare beneficiaries with diabetes were not receiving the quality of care needed. The Balanced Budget Act of 1997 expanded coverage, allowing these patients to acquire the skills needed to improve their disease management.
The law anticipates the expanded coverage will increase access for beneficiaries to quality diabetes self-management training and will eventually result in both improved health for Medicare beneficiaries with diabetes and significant Medicare savings.
HCFA is also studying other aspects of providing care for beneficiaries diagnosed with diabetes to ensure that Medicare beneficiaries are receiving the best care available.
A certified national accreditation organization must approve a self-management training program before the program can receive Medicare reimbursement. To gain this recognition from Medicare, a certified national accreditation organization must submit an application and supporting materials for HCFA review. HCFA will approve those accreditation organizations that meet or exceed HCFA's quality standards, or use the national standards that are recognized in the 1997 budget law and are administered by the American Diabetes Association, and also can assure HCFA the programs they accredit furnish quality services to beneficiaries.
A Federal Register notice also will be published tomorrow, outlining the requirements for national accreditation organizations.
