Click here to read the 2017-2018 Medicare Reimbursement Learning Collaborative Final Report.
- Area Agency on Aging, Region One; Phoenix, AZ
- Lake County Tribal Health Consortium; Lakeport, CA
- Southwestern CT Agency on Aging, Inc.; Bridgeport, CT
- Senior Connection Center, Inc; Tampa, FL
- Spectrum Generations; Augusta, ME
- Jewish Family Service of Metropolitan Detroit; Bloomfield, MI
- Oasis Institute; St. Louis, MO
- Nebraska Department of Health and Human Services; Lincoln, NE
- Piedmont Triad Regional Council Area Agency on Aging; Kernersville, NC
The purpose of this learning collaborative is to achieve integrated, sustainable service systems for Chronic Disease Self-Management Education (CDSME) programs by supporting state and community-based organizations as they work to obtain accreditation for their diabetes programs and payment for CDSME services through three distinct Medicare benefits: Diabetes Self-Management Training (DSMT), Medical Nutrition Therapy (MNT), and Health and Behavior Assessment and Intervention (HBAI).
These Medicare benefits are vastly underutilized, and this learning collaborative will help participating organizations bring these valuable services to more people. Throughout the course of the learning collaborative, participants will develop business acumen skills to demonstrate the value of their services and to position themselves as viable providers of CDSME programs.
The DSMT benefit is designed to help individuals cope with and manage their diabetes. DSMT provides an avenue for billing the Stanford Diabetes Self-Management Program (DSMP) when additional requirements are met, including accreditation from a national organization, the American Association of Diabetes Educators (AADE) or the American Diabetes Association (ADA). The MNT benefit can be used in conjunction with DSMT to provide nutrition assessment and counseling.
The HBAI benefit is an intervention to help individuals address psychosocial factors that negatively affect their medical treatment and self-management/self-care. HBAI provides an avenue for billing the Stanford Chronic Disease Self-Management Program (CDSMP) and other CDSME programs when the appropriate infrastructure, beyond the Stanford requirements, is established.
Participants will be asked to select either DSMT, in conjunction with MNT, or HBAI as their area of concentration for the learning collaborative. The learning collaborative experience will provide opportunities for peer-to-peer learning; mentorship from aging service professionals whose organizations have successfully achieved accreditation and payment for CDSME services; and enhanced support, training, and technical assistance from the National CDSME Resource Center. Findings will be documented and shared with the broader network and used to inform future learning collaboratives.
Twelve months from April 2017 through March 2018
By March 31, 2018, participating organizations will achieve or make significant progress toward achieving Medicare payment for their CDSME programs through the DSMT and MNT or HBAI benefits and accreditation for their diabetes programs (for those who concentrate on DSMT). Progress toward an overall “framework of change” to achieve this aim will be evidenced by the following incremental steps or “stages of change:”
- An implementation plan in place, including the necessary partnerships to carry out the plan;
- Changes focused on accreditation (for those who concentrate on DSMT), e.g., establishing an advisory group, conducting a test class, submitting the application, and ultimately attaining AADE or ADA accreditation;
- Appropriate clinical supervision and oversight;
- Billing processes established, including obtaining a Medicare Provider Transaction Access Number (PTAN) or forming an agreement with a Medicare provider that will partner in billing the services, and ultimately, submission and payment of a claim;
- A system for documenting and tracking the services that are provided; and
- Referral partner agreements to create service volume.
Support from the National CDSME Resource Center
The learning collaborative is designed to create a rich learning environment in which participants work together with enhanced support, training, and technical assistance from the National CDSME Resource Center, in collaboration with the Administration for Community Living. The Center will provide:
- Orientation and a list of recommended readings;
- Monthly conference calls/webinars that provide subject matter expertise on select topics, while facilitating group discussions and peer-to-peer sharing;
- One-on-one technical assistance with Tim McNeill (subject matter expert) initially, at midpoint, at the conclusion of the learning collaborative, and as needed throughout the twelve-month period;
- Mentorship from aging service professionals whose organizations have been successful in achieving AADE or ADA accreditation and Medicare payment;
- An online community for sharing information, resources, and best practices and for tracking progress; and
- An in-person learning collaborative session, in conjunction with the annual NCOA Resource Centers meeting (May 2017) for those planning to attend.
Up to 10 organizations will be selected to participate in this Learning Collaborative and will be announced by mid-April, 2017. Participants are expected to:
- Attend an online orientation training and participate in monthly calls/webinars;
- Become familiar with the recommended readings and resources;
- Identify key partners to serve on their learning collaborative team and assign a liaison, who will coordinate the effort and represent the team on the monthly calls/webinars;
- Complete a Readiness Review to identify their stage of readiness to achieve the aim;
- Collaborate with their team to develop an implementation plan, including measurable goals and objectives;
- Work closely with their partners to carry out the necessary action steps to achieve the aim; and
- Share challenges, progress, and lessons learned and be willing to serve as a mentor to support participants in the next generation learning collaborative.
NCOA’s Community Integrated Health Care Toolkit, Medicare Opportunities – All participants should read Learn the Basics. Under Make It Happen, participants should familiarize themselves with the sections that relate to their area of concentration, i.e., DSMT and MNT or HBAI. For DSMT, it is suggested to start with the Tip Sheet and FAQs.
Please contact Marissa Whitehouse at firstname.lastname@example.org with any questions regarding this charter.