Senators Lobby CMS for Telehealth Coverage in Diabetes Prevention Programs

A group of Senators is asking the Centers for Medicare & Medicaid Services to expand Medicare reimbursement for Diabetes Prevention Programs to include telehealth platforms.

In a letter to Health and Human Services Secretary Alex Azar and CMS Administrator Seema Verma, the Senators note that the ongoing Coronavirus pandemic is forcing people to remain in their homes and reducing access to care. They also note that HHS and CMS have enacted several emergency measures allowing more providers to use telehealth and mHealth.

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Allowing Medicare coverage for virtual DPP programs would “dramatically expand access to beneficiaries in need,” the letter states.

“This step would both enable access for millions of eligible beneficiaries and provide key foundational data on the effectiveness and integrity of virtual programs within the MDPP,” it adds.

This isn’t a new argument.

Last November 19 Senators – including the 12 signing this most recent letter – urged Azar and Verma to allow Medicare coverage of connected health platforms. That letter was prompted by news reports that DPP programs weren’t reaching large numbers of people. In addition, the American Medical Association and American Diabetes Association have lobbied CMS to expand coverage.

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, CMS created the National Diabetes Prevention Program for Medicare beneficiaries and launched that program in 2018.

But the Medicare model does not reimburse care providers for using telehealth or mHealth tools. And that’s keeping a lot of healthcare providers and public health programs from adopting the program.

Some 70 healthcare providers are now listed on the CDC’s DPP website, though only a handful have been recognized as offering proof that their online programs reach recognized benchmarks for activity and weight loss. A growing number of programs are using virtual care as a means of expanding the program’s reach and making the most of limited resources, and they’re asking CMS to cover those services.

The latest effort takes into account the broad expansion of telehealth rules to help providers address the COVID-19 pandemic. In their letter, the Senators argue for at least enabling telehealth coverage during the crisis, but also considering making that coverage permanent.

“The COVID-19 public health emergency exemplifies the importance of integrating virtual health technology solutions into our healthcare system on a sustainable, long-term basis, and we will continue to work to ensure that CDC-recognized virtual providers are full participants in the MDPP expanded model,” they wrote. “In the near term, however, we ask that you protect at-risk populations and preserve and bolster access to a proven program by allowing for robust and meaningful virtual provider reimbursement eligibility during this public health emergency.”