DSMT has been a covered benefit under Medicare for more than 15 years. Despite the undisputed benefits of DSMT for people with diabetes — lower hemoglobin A1c, weight loss, improved quality of life, healthy coping skills and reduced health care costs — only 5% of Medicare beneficiaries with newly diagnosed diabetes used DSMT services.
The Expanding Access to DSMT Act addresses barriers identified by the Academy and our partners in the Diabetes Advocacy Alliance for Medicare beneficiaries to utilize DSMT benefits:
- Expand access by permitting physicians and qualified nonphysician practitioners who are not managing an individual's diabetic condition, but who are acting in coordination with the physician or nonphysician practitioner managing the individual's diabetic condition to order DSMT services.
- Extends the initial 10 hours of DSMT covered by Medicare beyond the first full year until fully utilized; provides for additional hours of DSMT as needed.
- Removes restriction relating to coverage of DSMT and MNT services furnished on the same day.
- Removes patient cost sharing and excludes DSMT from the deductible requirements.
- Revises the Medicare Benefit Policy Manual to allow DSMT services to be furnished by a hospital outpatient department at nonhospital site, such as a community-based location.
- Calls for a Virtual DSMT demonstration project at CMMI to test the effectiveness of virtual DSMT.