Senators Eye Medicare Coverage for Telehealth in Diabetes Prevention Programs

A group of Senators has re-introduced a bill that would establish Medicare coverage for care providers who use telehealth in diabetes prevention programs.

The Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies Act, which is shortened to the PREVENT DIABETES Act, would amend the guidelines of the Medicaid Diabetes Prevention Program’s Expanded Model to include virtual programs.

The bill is sponsored by Senators Tim Scott (R-SC) and Mark Warner (D-VA), along with Shelley Moore Capito (R-WV), Tom Cotton (R-AR), Kevin Cramer (R-ND), Cindy Hyde-Smith (R-MS), Kyrsten Sinema (D-AZ) and Tina Smith (D-MN). A similar bill was introduced in April in the House of Representatives.

“Our bill not only expands access to life-saving health care options for those who already have the disease, but it also supports programs that can delay or prevent the full onset of diabetes,” Scott, who first introduced the bill in September 2020 with Warner, Cramer, Sinema, Smith and then-Senator Tom Cotton (R-AZ), said in a press release. “By opening the door to virtual suppliers, we can ensure all patients have access to care regardless of zip code.”

The bill targets a long-running complaint among telehealth advocates.

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. 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.

The Medicare Diabetes Prevention Program Expanded Model was launched in 2019 by the Center for Medicare and Medicaid Innovation, but it doesn’t reimburse care providers for using connected health platforms. CMS has argued that they haven’t received enough evidence that virtual care reduces costs or improves outcomes to support Medicare coverage.

COVID-19 may be changing that discussion, and many are hoping that the expansion of telehealth services and coverage during the pandemic will be made permanent. Advocates note that many DPPs either adopted virtual platforms or even switched to all-virtual services to avoid in-person treatment and reach a wider population in need of these services.

The bill has the support of dozens of organizations, including the American Diabetes Association, Alliance for Connected Care, American Telemedicine Association, Connected Health Initiative and National Kidney Foundation.

“Increasing access to virtual diabetes prevention services is critically important to the health and wellbeing of our nation’s seniors,” those groups wrote in a recent letter. “Virtual diabetes prevention models can offer flexibility to engage in sessions at a time most convenient, can increase accessibility by eliminating barriers to care such as childcare and transportation that we know disproportionately affect minority and low-income communities, and include virtual tools for continuous goal setting and tracking.”

Roughly one in every three Americans, or 88 million people, have health characteristics that put them at risk of developing type 2 diabetes. Diabetes prevention programs target that population with group and individual treatments that focus on behavior change to support better diet and exercise.