CMS Mulling Medicare Reimbursement for Virtual Diabetes Programs

February 26, 2020 - CMS officials are reportedly looking at allowing Medicare reimbursement for Diabetes Prevention Programs that use telehealth and mHealth.

The news comes from Politico, which reported today that Seema Verma, the Centers for Medicare & Medicaid Services’ administrator, sent a letter to lawmakers in January saying CMS is “currently exploring ways” to support virtual care reimbursement.

Verma’s comments were in response to a letter sent late last October by 19 senators asking them to make CDC-recognized virtual care providers eligible for Medicare reimbursement in the MDPP expanded model.

“A Medicare beneficiary’s access to the life-improving program should not, and cannot, be determined solely by the zip code in which he or she lives,” the senators wrote. “Furthermore, lack of access for eligible beneficiaries has the potential to not only depress enrollment, but also to reduce potential cost savings.”

“CMS has done outstanding work developing online resources to show where MDPP suppliers are located, but these resources make clear that there are geographic regions where eligible beneficiaries lack reasonable access to a qualified supplier,” the letter continues. “Including virtual providers could empower these beneficiaries with feasible options for preventive, value-based care.”

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.

CMs has refrained from including connected health programs in Medicare reimbursement, arguing that not enough evidence exists that these programs improve outcomes. Verma’s letter to lawmakers suggests that lobbying efforts by both Congress and the telehealth industry may be prompting her and Health and Human Services Secretary Alex Azar to reconsider.

Including virtual care services could also help what some see as a struggling program. Politico has also reported that few Medicare beneficiaries are accessing the DPP, well below the tens of thousands that had been expected to take advantage of the program. Roughly 84 million Americans are at risk of developing type 2 diabetes.

In its own lobbying effort, the American Medical Association said the inclusion of virtual care services could improve access to the program for millions of underserved Americans.

“We recognize that scaling an ambitious new model takes time,” the organization said in an October 2019 release supporting the letter to CMS from Congress. “Early returns suggest that a few changes would expand the program’s reach. Allowing Medicare patients to virtually access this program, as many patients with private insurance are doing, would benefit the most underserved and vulnerable patients, as well as those in remote areas, who cannot access the program without this option. Here is an opportunity for Medicare to encourage a practical use of digital health tools.”