Diabetes council rolls up sleeves

WASHINGTON – The new AAHomecare Diabetes Council has plenty to tackle with new technology requiring updated codes and coverage criteria.  

CMS recently released a proposed local coverage determination for continuous glucose monitors (CGMs) that would increase access for Medicare beneficiaries by modifying coverage criteria to, among other things, eliminate the intensive insulin management requirement.  

“(The diabetes space) is just so dynamic and it’s exciting to have a group of suppliers who are on the frontline servicing beneficiaries working together in hopes to best shape policy to best serve those beneficiaries,” said Linda Langiotti, senior vice president of strategic channels for CCS Medical, who chairs the council. “We’ve been underrepresented in this space.”  

The council, comprised of AAHomecare Corporate Partners, held its inaugural meeting in October, during which it set initial goals and identified some key priorities, primarily related to upcoming Medicare changes.  

The DME MACS in early November also announced new codes for therapeutic CGMs, effective Jan. 1, but providers don’t yet know how that will impact beneficiaries who are dual eligible for Medicare and Medicaid, says Langiotti. 

“Traditionally, state Medicaid FFS and Managed Medicaid plans that follow their guidance may not adopt new codes as quickly as Medicare releases them,” she said. “For the supplier community, this means when Medicare claims cross over to Medicaid secondary, we would not be paid the co-insurance simply because of the new coding.”  

Other items on the council’s to-do list: supporting coverage of CGMs under the DME benefit, not just the pharmacy benefit; increasing Medicaid coverage for diabetes technology; and developing a white paper to highlight outcomes, says Tom Ryan, president and CEO of AAHomecare.  

“We want to make sure we can demonstrate we have good compliance – that’s what we do best,” he said. “CGMs give patients the ability to see in real time what blood glucose levels are and treat it. We think it’s all lining up for a great opportunity for AAHomecare to advocate.”