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HHS/CMS

RIN: 0938-AI96

Publication ID: Fall 2000

Title: Expanded Coverage for Diabetes Outpatient Self-Management Training Services (HCFA-3002-P)
Abstract: This rule would provide for uniform coverage of diabetes outpatient self-management training services. These services include educational and training services furnished to a beneficiary with diabetes by an entity approved to furnish the services. The physician or qualified nonphysician practitioner treating the beneficiary's diabetes would certify that these services are needed as part of a comprehensive plan of care. This rule proposes the quality standards that an entity would be required to meet in order to participate in furnishing diabetes outpatient self-management training services. It sets forth proposed payment amounts that have been established in consultation with appropriate diabetes organizations. It would implement section 4105 of the Balanced Budget Act of 1997 (BBA).
Agency: Department of Health and Human Services(HHS)	Priority: Economically Significant
RIN Status: Previously published in the Unified Agenda	Agenda Stage of Rulemaking: Final Rule Stage
Major: No	Unfunded Mandates: No
CFR Citation: 42 CFR 410 42 CFR 414 42 CFR 424 42 CFR 476 42 CFR 498
Legal Authority: 42 USC 1302 42 USC 1395hh 42 USC 1395x

Legal Deadline:

Action	Source	Description	Date
NPRM	Statutory		07/01/1998

Statement of Need: Section 4105 of the BBA provided for coverage of diabetes self-management training to include services provided in nonhospital-based programs. This proposed rule would expand Medicare coverage for diabetes outpatient self-management training; define who may be a certified provider of services that may provide diabetes outpatient management training services; explain that the physician managing the patient's diabetes must certify that the services are needed under a comprehensive plan of care; and sets standards for certified providers that have been established in consultation with appropriate diabetes organizations.

Summary of the Legal Basis: Section 4105(a) of the BBA provides coverage for diabetes outpatient self-management training. Under this coverage, training would include educational and training services furnished in an outpatient setting (according to frequency standards established by the Secretary) to a beneficiary with diabetes by a "certified provider" that meets certain quality standards.

Alternatives: Coverage is provided for in section 4105(a) of the BBA, therefore, no alternatives to issuing this regulation exist.

Anticipated Costs and Benefits: Projected Budget Impact of New Benefit ($ in millions): $60 in FY 1998; $560 in FY 1999; $230 in FY 2000; $80 in FY 2001; and $80 in FY 2002. An estimate of benefits has not been established.

Risks: If the diabetes self-management training is not implemented, our diabetic beneficiaries will not receive information for improving their long term health that would result from this rule.

Timetable:

Action	Date	FR Cite
NPRM	02/11/1999	64 FR 6827
Final Action	12/00/2000

Regulatory Flexibility Analysis Required: No	Government Levels Affected: None
Small Entities Affected: Businesses, Organizations	Federalism: Undetermined
Included in the Regulatory Plan: Yes
Agency Contact: Betty S. Burrier Department of Health and Human Services Centers for Medicare & Medicaid Services S3-02-01, Office of Chronic Care Insurance Policy, Bureau of Policy Development, 7500 Security Boulevard, Baltimore, MD 21244-1850 Phone:410 786-4649