[Federal Register: October 26, 2007 (Volume 72, Number 207)]
[Notices]
[Page 60856-60857]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr26oc07-72]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-3181-FN]
Medicare Program: Approval of Application by the American
Diabetes Association (ADA) for Continued Recognition as a National
Accreditation Organization That Accredits Entities To Furnish
Outpatient Diabetes Self-Management Training
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final notice.
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SUMMARY: This final notice announces the approval of the American
Diabetes Association (ADA) as a national accreditation organization for
the purpose of determining that an entity meets the necessary quality
standards to furnish outpatient diabetes self-management training
services under Part B of the Medicare program.
[[Page 60857]]
Therefore, diabetes self-management training (DSMT) programs accredited
by the ADA will receive deemed status under the Medicare program.
DATES: Effective Date: This accreditation is effective on October 27,
2007.
FOR FURTHER INFORMATION CONTACT: Joan A. Brooks, (410) 786-5526.
SUPPLEMENTARY INFORMATION:
I. Background
To participate in the Medicare program, diabetes self-management
training (DSMT) programs must meet conditions for coverage specified in
our regulations at 42 CFR part 410, subpart H. One requirement is that
entities must satisfy required quality standards. Currently, one way of
satisfying the quality standards under Sec. 410.145 is to be approved
by an approved accrediting body. The regulations pertaining to the
application procedures for national accreditation organizations for
DSMT are at Sec. 410.142. After we approve and recognize the
accreditation organization, it may accredit an entity to meet one of
the sets of quality standards described in Sec. 410.144.
II. Review Process
In evaluating an application from an accrediting organization, we
consider the following factors under section 1865(b)(2) of the Social
Security Act (the Act):
Accreditation requirements.
Survey procedures.
Ability to provide adequate resources for conducting
required surveys and to supply information for use in enforcement
activities.
Monitoring procedures.
Ability to provide us with the necessary data for
validation.
We are required by Sec. 410.142(d) to publish a proposed notice in
the Federal Register after the receipt of a written request for
approval from a national accreditation organization. After review of
the national accreditation organization's application, the regulations
require that we publish a notice of our approval or disapproval after
we receive a complete package of the information and the organization's
deeming application.
III. Analysis of and Responses to Public Comments and Provisions of the
Final Notice
We received a complete application from the American Diabetes
Association (ADA) on March 3, 2007. On May 25, 2007, we published a
proposed notice in the Federal Register, (72 FR 29325) announcing the
application of the ADA for continued approval as an accreditation
organization for diabetes self-management training programs.
Comment: We received one comment on our proposed notice, which was
supportive of the ADA's application. Although the comment supported
ADA, the commenter expressed concern that some of ADA's accrediting
requirements do not reflect the current state of health care practice
for many DSMT programs. Specifically, the commenter expressed concern
about the requirements pertaining to data collection, documentation,
location requirements, and fees. The commenter stated that
accreditation requirements can be burdensome for small DSMT practices
that may operate outside of a large hospital-based setting. The
commenter further specified that some large hospitals' DSMT programs
have closed in recent years, due to a variety of factors that include
the burdensome administrative requirements of accreditation combined
with overall low reimbursement for DSMT services.
Response: Although reimbursement issues are not within the scope of
this final notice, we recognize these are issues of concern. Some
reimbursement issues associated with DMST are--
Entities' failure to meet the required number of
participants for group training;
Entities' failure to meet the requirement for both a
registered dietician (RD) and a registered nurse (RN) on the training
team; and
Entities' failure to bill correctly.
Recent revisions made to the National Standards for Diabetes Self-
Management Education Programs (NSDSMEP) include: 1) a reduction in the
number of participants required for group training (from 15 to 10); and
2) a change in the instructional requirements that DSMT programs must
meet. Previously, a DSMT entity was required to have both a RD and a RN
conduct training. The recent revisions to the NSDSMEP changed this
requirement. An entity may now have either a RD or a RN conduct
training. This revision should help to alleviate some of the
administrative burdens faced by entities when administering the DSMT
benefit. Additionally, we have revised Chapter 18 of the CMS Claims
Processing Manual, and Chapter 15 of the CMS Benefits Policy Manual to
clarify the instructions for filing specific claims. Our findings
indicate that the ADA continues to use one of the sets of quality
standards described in Sec. 410.144. It also continues to meet the CMS
criteria as ``a nonprofit organization with demonstrated experience in
representing the interests of individuals with diabetes'' to accredit
entities to furnish training as specified in Sec. 410.142(a).
The ADA began its Education Recognition Program (ERP) in 1986. At
that time they formally recognized diabetes self-management education
programs that meet the NSDSMEP. These standards, created by the
National Diabetes Advisory Board (NDAB), were designed to promote
quality diabetes self-management education nationwide for every person
with diabetes.
A Task Force consisting of the ADA, the American Association of
Diabetes Educators, the American Dietetic Association, the Veteran's
Health Service, the National Certification Board for Diabetes
Educators, the Centers for Disease Control and Prevention, the
Department of Veterans Affairs, the Diabetes Research and Training
Centers, the Indian Health Service, and the National Certification
Board for Diabetes Educators was convened on March 31, 2006 and again
on September 19, 2006 as part of the update process. The revised
standards were approved on March 25, 2007 and was published in the June
2007 issue of Diabetes Care, Volume 30, Number 6. The task force
reviewed the standards for their appropriateness, relevancy, scientific
basis, specificity, and ability to be implemented in multiple settings.
The current NSDSMEP standards (7th Edition) were effectuated in June
2007 and reflect the changing approaches in diabetes training and
education.
We reviewed ADA's materials and the findings presented by the Iowa
Foundation for Medicare Care (IFMC, Contract GS-35F-5831 H/
HHDM 500-2006-0015IG), which was under contract with CMS to validate
ADA's accreditation policies. IFMC surveyed a sample of ADA's
accredited facilities. Based on these reviews, we have determined that
the ADA's deeming authority has been exercised in compliance with Sec.
410.142. Therefore, ADA's continued recognition as a national
accrediting organization is approved and is effective for 6 years,
beginning October 27, 2007.
Authority: Sections 1865 of the Social Security Act (42 U.S.C.
1395bb).
(Catalog of Federal Domestic Program No. 93.773, Medicare--Hospital
Insurance Program; and No. 93.774, Medicare-Supplementary Medical
Insurance Program)
Dated: September 6, 2007.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E7-20495 Filed 10-25-07; 8:45 am]
BILLING CODE 4120-01-P