There are currently two identical bills (Assembly A3460 and Senate S2191) that would provide Medicaid funding for Diabetes Self Management Training (DSMT) for those with diabetes and with pre-diabetes. Though sounding positive, these bills are problematic for several reasons:
- In order to gain insurance reimbursement for people with their credential, the American Association of Diabetes Educators (AADE) wants holders of it's credential specifically named in the bill as covered providers. By naming "Diabetes Educators" as a profession in the bill, this would create an occupational regulation based on a disease rather than on a profession. This has never been done before and opens the door to Cardiovascular Educators, Cancer Educators, etc. all having new and separate licenses (which is something AADE states on its website that it is seeking for Diabetes Educators).
- DSMT is a very specific type of well-defined service for people with diabetes. It includes, among other things, medication use, management, glucose monitoring, etc. This bill would push pre-diabetes services into the DSMT category, creating a bad precedent to "medicalize" preventive education and limit who could provide it.
- These bills would significantly limit access to services, especially for pre-diabetes. There is strong evidence demonstrating the effectiveness of diabetes prevention programs (DPP) that are delivered by individuals, such as health coaches and community health workers, who are trained according to a CDC-standardized protocol. The CDC protocol specifically states both credentialed and non-credentialed personnel can effectively deliver this program. Data shows these programs can reduce diabetes by 58% across racial groups.
- These bills name only a small group of qualified providers excluding, for example, nutritionists, nurse practitioners, health coaches, naturopathic physicians and others who may be well-qualified to offer these services.
We support Medicaid coverage for these services, but this bill is flawed in many ways and needs to be rewritten after all stakeholder are brought to the table to get it right.