Lawmakers Again Seek Medicare Coverage of Telehealth in Diabetes Prevention Services

Lawmakers are once again being asked to add telehealth services to the Medicare Diabetes Prevention Program, giving healthcare providers more tools to improve the health and wellness of millions at risk of getting the chronic disease.

Four members of Congress last week introduced the Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-Based Strategies (PREVENT DIABETES) Act, which would enable Medicare coverage of connected health services in the MDPP.

The original Diabetes Prevention Program was developed by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), and focused on in-person classes and one-on-one coaching to reduce weight and improve lifestyle choices. Based on that model, which is administered by the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services created the National Diabetes Prevention Program for Medicare beneficiaries and launched that program in 2018.

But the MDPP Expanded Model doesn’t reimburse care providers for using telehealth to connect with and coach patients. CMS has in the past said that virtual care hasn’t been proven in diabetes prevention program to affect significant weight loss or reduce costs.

Telehealth and mHealth advocates disagree, and have been lobbying for years to add those services, saying a virtual platform would reach far more people at risk and enable providers to make better use of limited resources.

Many diabetes prevention programs do make use of virtual care, and a number of private payers are supporting the service. But Medicare coverage would open the program to millions of new people, especially those in underserved regions and populations, where diabetes is rampant.

"Expanding virtual access to the Diabetes Prevention Program is incredibly important as it is a critical Medicare service,” US Rep. Tom Reed (R-NY), one of the bill’s co-sponsors and a co-chairman of the Congressional Diabetes Caucus, said in a press release introducing the new bill. “By doing this, we will ensure more Americans can utilize the informational resources they need to make healthy decisions.”

Last September, the same bill was introduced in the US Senate, but that bill – like so many others related to telehealth – failed to make the grade.

As with last year’s bill, this one has strong support. Among those backing the effort are ACT | The App Association, the American Diabetes Association, the American Medical Association, the American Telemedicine Association and the Alliance for Connected Care, which sent a letter earlier this month asking Health and Human Services Secretary Xavier Becerra to include virtual care coverage during the public health emergency created by the coronavirus pandemic and “work on longer-term reforms” that would make connected health a permanent part of the program.

“It is widely acknowledged that quarantines during the PHE have resulted in increased weight gain and therefore risk of Type 2 diabetes,” the letter stated. “Furthermore, the strains of the pandemic have severely impacted in-person diabetes prevention programs – which were already financially strained – causing many Medicare beneficiaries to lose access to DPP services.”

“Given the ongoing and worsening prediabetes challenges facing seniors, expectations that the PHE will continue throughout 2021, and the cessation of many in-person DPP programs, we believe CMS must act immediately to preserve access to these services,” the letter concluded. “We believe that the Department of Health and Human Services should immediately use its emergency authority to remove in-person requirements from Medicare DPP services for the remainder of the COVID-19 PHE. We then strongly recommend that data from this expansion be leveraged to evaluate the merits of expanding virtual MDPP services permanently.”