Proposed legislation currently winding its way through the Congressional chambers calls for better diabetes education and aims to boost the number of educators who get reimbursed for serving people with diabetes on Medicare.
The American Association of Diabetes Educators (AADE) is the key organization behind this bill, and it says this new law is crucial to make sure that our country has enough professionals offering quality diabetes education to our growing, and aging, D-Community.
It's called the Access to Quality Diabetes Education Act, and there are companion bills in both the U.S. House and Senate. These were introduced in early 2015, and they mirror the legislation that was proposed but not approved in past years.
But there's some serious opposition here! According to a new coalition fighting this legislation, the impact would be anything but positive. Instead, this coalition believes the Act would cut down on the number of educators and leave PWDs (people with diabetes), especially those on Medicare, with even fewer options.
Say hello to the #DiabetesMiseducation campaign, which appeared seemingly out of nowhere last week with a media blitz hitting social media and placing op-eds in publications like Politco, raising concerns about this legislation, which has been largely uncontested until now.
The coalition's big gripe: this legislation would require "certification," meaning those who want to work in diabetes education must go through many hours of training and a comprehensive exam to get to a level that right now only half of the educators in the U.S. actually have. In other words, community educators, dieticians, holistic medicine practitioners and others would be shut out in favor of those with the CDE (certified diabetes educator) qualification.
Not so, says the leadership at AADE. The educator group says the proposed law would only amend the rules to add certified AND state-licensed educators to the ranks of those getting reimbursed by Medicare. AADE's recent push for state licensing of educators is one that our own patient advocate community welcomed, as it allows people to be recognized as diabetes educators without going through the formal route of racking up hours to qualify for the National Certification Board for Diabetes Educators (NCBDE) exam.
In many ways, it's a "He Said, She Said" scenario here since legislation is always open to interpretation, even by those responsible for enforcing it.
Access to Quality of Diabetes Education Act (and AADE POV)
The legislation in question actually includes two bills -- House Bill 1726 and Senate Bill 1345 -- both proposed in the first half of the year and currently "in committee" (government word for under evaluation).
The legislation amends Medicare/Title XVIII of the Social Security Act, and specifically the part of this federal law pertaining to recognizing state-licensed educators, registered CDEs, and health care professionals who specialize in diabetes education. A key focus here is the language describing “diabetes outpatient self-management training services” and who is eligible to offer those services and be reimbursed.
The legislation also includes provisions to increase patient access -- such as directing the federal government to actually study the barriers PWDs on Medicare face in getting diabetes education, and to develop recommendations on how Medicare could achieve better outreach to physicians and the general public about diabetes education.
Sounds good, right?
The AADE thinks so, and that's why it's been pushing for this legislation for a long time. In the social media world, AADE has been using the #DiabetesEd4all hashtag on Twitter to help spread the word.
We asked the AADE leaders about what this legislation would and wouldn't do, and this is what we're told by the group's state and federal Advocacy Director Kurt Anderson:
- This bill is just an amendment to an existing law, meant to expand Medicare coverage of diabetes education.
- It does not mandate that all providers of diabetes education have the Certified Diabetes Educator (CDE) or the Board Certified-Advanced Diabetes Management (BC-ADM) credentials. To say otherwise is misleading. In fact, it enlarges the pool of those who can be reimbursed for offering the Medicare benefit. The result: increased access to diabetes education.
- This would add all CDEs and BC-ADMs to the current list of those who can already bill Medicare for diabetes education -- so it just addresses gaps but doesn’t affect those who have been providers for years. Examples include physicians, physician assistants, nurse practitioner, and registered dietitians.
- Once the bill passes, Medicare's governing body CMS wil be responsible for implementing it and communicating with all affected entities about how it works.
After reading the proposed versions of both bills, honestly to me it seems like AADE is on the correct side of the argument here. Keep in mind, I spent the better part of a decade as a law journalist, covering appellate courts where I regularly read state and federal statutes, and saw how attorneys and courts interpreted what is written. So I like to think I have a leg to stand on here.
Sure, this is an amendment to a very complicated matrix of laws. What it aims to do is add certified or state-licensed diabetes educators to the roster of those getting reimbursed from Medicare. Based on my own reading, what it does not do is say that only those certified folks are allowed to do that job.
Right now, across the board, educators don't get reimbursed as they should. This law change is trying to change that, so maybe more people will go into this important field to help those of us who are pancreatically-challenged.
Other groups have been weighing in with Congress to support this legislation too -- including the American Foundation for the Blind, the Telemedicine Association, and most recently the Diabetes Advocacy Alliance that includes 20 member groups ranging from patient advocacy, providers, industry, non profit, and nutrition/dietician interests.
Who's Behind the Diabetes Miseducation Coalition?
The coalition describes itself as "a group of health and wellness organizations building a movement to protect diversity in diabetes management and prevention teams and to expand patient access to quality diabetes education."
They have a flashy website with a bunch of stats that proclaim how this proposed legislation would dramatically change the world of diabetes education and devastate PWDs on Medicare, and they've been bombarding social media with hashtag #DiabetesMiseducation.
No one with the Diabetes Miseducation coalition returned our calls on this by deadline, so we're left to wonder just where this whole group came from. But you can get an idea just by scrolling the list of founding members:
- International Association for Health Coaches
- National Association of Nutrition Professionals
- Nutrition Therapy Association
- National Health Freedom Coalition
- University of Natural Health
- Maryland University of Integrative Health
- Alliance for Natural Health USA
- American School of Natural Health
- Institute for Transformational Nutrition
Picking up on any themes there?
One of the points this D-Miseducation campaign raises is how many policy-makers, including the White House with a new policy paper, are moving against the idea of occupational licensing in general. They extend this to diabetes educators, as well, and make the argument that anyone should be free to offer diabetes education services without a state license or national certification.
The whole argument boils down to disagreement with the AADE about state licensing and certification... and that is a valid debate.
But by tying this to the legislation and claiming that it "requires" that licensing or certification, the coalition is flat-out wrong and taints the otherwise legitimate case it could be making on this state licensure topic, IMHO.
Look, we've not always been fans of how the AADE has handled diabetes education topics. We've long criticized the certification process, advocating that the group should do more to make it easier for new educators to enter the field. And as noted, they have moved more toward state licensing in recent years, and in 2012 they also added the what they call the Career Path Certification to help prepare community health workers and others get into D-education professionally.
Obviously, it doesn't completely eliminate training requirements and that irks many people -- especially those in this D-Miseducation group who work as health coaches, all-natural health consultants, and so on.
Politics of Diabetes Education
What's so interesting about this whole coalition is that, once again, it puts AADE right in the middle of the controversy.
Remember that spin-off group the Academy of Certified Diabetes Educators (ACDE) that came into existence last year? That was created in large part because many professionals felt that AADE was going too soft on the certification issue and should not be allowing non-certified folks of any ilk to take on diabetes education.
Well, now we have this Diabetes Miseducation group that's on the polar opposite extreme, saying the AADE should let go of certification and training requirements altogether, for an open field, so to speak.
Our big question as always is: What about the patients? Where does all of this leave us, who so desperately need good diabetes education to help us succeed?
Just like voters left adrift amidst the ineffective political mess known as Congress, we PWDs are left flapping in the wind while the powers-that-be in diabetes education fight amongst themselves about whose career is recognized how.
Personally, I don't care about the clout part of certification per se. But I do want someone who "knows their stuff" on this disease as part of my D-management team -- and that may not be a yoga instructor or natural diet fanatic with some agenda to push. Give me access to educators that I can choose from, with info about their backgrounds and skillsets, and let me take it from there, please.
We also understand how important it is for these folks to get paid for the work they do, and that when that's not the case it can be challenging to not only stay in that role but encourage others to take that path. So, we need to make sure our diabetes educators are getting paid adequately for what they provide (which will result in increased patient access). And in our view, this Act is a step in the right direction.