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Re: [IP] Help- pumpers



At 07:18 PM 4/15/00 -0700, you wrote:
> > > I was reading the "Medicare guidelines for pump coverage"
>and
> > > was stunned when I saw
>the "requirements"
> > > for authorization of pump coverage.

I may have missed part of this thread but there seems to be some confusion 
on my part or others in reading the requirements. To me there are two types 
of patients the requirements seem to cover. Criteria A is for the patient 
currently on Medicare and beginning pump usage. I say this because of the 
Press Release titled Medicare Will Cover Insulin Pumps For Beneficiaries 
located at 
<http://www.hcfa.gov/news/pr1999/pr990924.htm>www.hcfa.gov/news/pr1999/pr990924.<http://www.hcfa.gov/news/pr1999/pr990924.htm>htm.Criteria 
B is for the patient currently using a pump and just starting with Medicare 
as stated. All type I diabetics must document a C-peptide of <0.5 
(confirmed by MiniMed). I am the guinea pig for my endo and doing all of 
his nurses leg work. I think I am helping myself being intermediary as I 
found out Friday a fax had not been returned to MiniMed authorizing them to 
supply glucose test strips for me. There are a lot of little things to be 
done to get pump supplies, one being Medicare will not allow fax or email 
requests for pump supplies. Only originals are acceptable, I guess the post 
office is working on a deficit again. Friday I got my test result on the 
C-peptide with my doctor reporting it as negative. If anyone sees something 
wrong with my reasoning please let me know and I will look it over. The 
highlights in the coverage manual excerpt below are mine.

In order to be covered, patients must meet criterion A OR B:

  (A) The patient has completed a comprehensive diabetes education program, 
and has been on a program of multiple daily
        injections of insulin (i.e. at least 3 injections per day), with 
frequent self-adjustments of insulin dose for at least 6 months prior
        to initiation of the insulin pump, and has documented frequency of 
glucose self-testing an average of at least 4 times per day
        during the 2 months prior to initiation of the insulin pump, and 
MEETS ONE OR MORE of the following criteria while on the
        multiple daily injection regimen:

  (1) Glycosylated hemoglobin level(HbAlc) > 7.0%

  (2) History of recurring hypoglycemia

  (3) Wide fluctuations in blood glucose before mealtime

  (4) Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl

  (5) History of severe glycemic excursions

  (B) The patient with Type I diabetes has been ON A PUMP PRIOR TO 
ENROLLMENT in Medicare and has documented frequency of          glucose 
self-testing an average of at least 4 times per day during the month prior 
to Medicare enrollment.

Type I diabetes needs to be documented by a C-peptide level < 0.5.

Jim

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