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[IP] Insulin Pump Coverage
FYI...Some of the list members might find this information useful..
<< HCFA Adds Coverage for Insulin Pumps
The Health Care Financing Administration has changed its policy for coverage
of insulin infusion pumps. HCFA will now begin covering pumps and related
supplies for Medicare Part B beneficiaries with type 1 diabetes.
In order for the pump to be covered, the patient must have completed a
comprehensive diabetes education program and been on a regimen of at least 3
insulin shots per day with frequent self-adjustments of insulin dose and be
self-testing blood glucose levels at least 4 times per day.
In addition candidates for Medicare insulin pump coverage must meet one or
more of the following criteria: (1) maintain a HbA1c level less than 7% (2)
a history of recurring hypoglycemia, (3) wide fluctuations in blood glucose
before mealtime (4) history of severe glycemic excursions (5) fasting blood
sugars above 200 due to dawn phenomena. Also, patients with type 1 diabetes
who had been on a pump prior to enrollment in Medicare would be eligible for
coverage upon enrollment in Medicare so long as they tested their blood
glucose level at least 4 times per day.
While choosing not to provide coverage for insulin pumps for Medicare
beneficiaries with type 2 diabetes, HCFA left the door open for
reconsideration of adding to the coverage policy at a later date.
AADE had supported expansion of Medicare coverage to include insulin pumps
along with the ADA and other organizations in the diabetes community. The
Mini-Med Corporation spearheaded the drive and had successfully sought
legislation that had been introduced into Congress to add insulin pump
coverage for Medicare beneficiaries.
California Law Adds Diabetes Coverage
California Governor Gray Davis has signed legislation that adds coverage for
diabetes education, equipment and supplies to the basic benefit provided by
comprehensive health insurance policies and managed care plans.
The bill was sponsored by Senator Hilda Solis (D-Los Angeles) and
Assemblymember Susan Davis (D-San Diego).
The legislation specifies a list of common diabetes supplies to be covered,
including podiatric devices and adaptive aids to assist the visually
impaired. Prescription plans will also be required to cover all prescriptive
medications along with insulin and Glucagon.
Under the new law diabetes self-management education and medical nutrition
therapy is to be provided by appropriately licensed or registered health
professionals. Education and MNT must have a physician order or prescription
when teaching to proper use of equipment, supplies or medication.
Any "additional" education or MNT must be "medically necessary" in addition
to having a physician order or prescription. It remains to be seen how much
of an obstacle the medical necessity criteria will be for patients seeking
comprehensive diabetes education services.
The new law takes effect on January 1, 2000 and applies to all policies and
contracts written or renewed after that date.
Congratulations to State Legislative Coordinators Kim Higgins, RN, CDE and
Louise Rahmann, RN, CDE and American Diabetes Association Regional Program
Director Lisa Murdock as well as the many California diabetes educators who
fought long and hard for passage of this legislation. >>
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