Click here to read the 2018-2019 Medicare Reimbursement Learning Collaborative Final Report.
- Big Sandy Health Care, Inc.; Prestonsburg, KY
- Central District Health Department; Grand Island, NE
- Community Council; Dallas, TX
- Connecticut Community Care, Inc.; Bristol, CT
- Council on Aging of Southwestern Ohio; Cincinnati, OH
- Delaware Department of Health; Dover, DE
- New Mexico Department of Health; Santa Fe, NM
- United Neighborhood Centers of Northeastern Pennsylvania; Scranton, PA
- Western New York Integrated Care Collaborative, Inc.; Buffalo, NY
The purpose of the Medicare Reimbursement Learning Collaborative (MRLC) 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 the following distinct Medicare benefits: Diabetes Self-Management Training (DSMT), Medical Nutrition Therapy (MNT), Health and Behavior Assessment and Intervention (HBAI), and Chronic Care Management (CCM).
These Medicare benefits are vastly underutilized, and this learning collaborative will help participating organizations bring valuable services to more people. Throughout the course of the MRLC, 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 gain the knowledge and skills needed to adopt self-care behaviors and make lifestyle changes to manage their diabetes and improve their health outcomes. DSMT provides an avenue for billing the Diabetes Self-Management Program (DSMP) originally developed by Stanford University when additional requirements are met, including supervision by a registered dietitian and accreditation/recognition from 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 nutritional assessment and counseling.
The HBAI benefit is an intervention to help individuals address behavioral, cognitive, emotional, or psychosocial factors that negatively affect their medical treatment and self-management/self-care. When a licensed clinical psychologist or nurse practitioner provides supervision and deems it medically necessary, the Chronic Disease Self-Management Program (CDSMP) or other CDSME programs originally developed by Stanford University can serve as a component of the HBAI clinical group benefit. Note: Some Medicare Advantage plans allow a licensed clinical social worker to provide the supervision.
The CCM benefit includes a broad range of services offered under the supervision of a physician, physician assistant, or nurse practitioner to help individuals with two or more chronic conditions follow their medical care plan, practice preventive health care, and more effectively manage their health. Only a small amount of time for a CDSME program can be billed under the CCM benefit. However, many activities ancillary to CDSME can be offered under the CCM benefit, e.g., engaging individuals, enrolling them in classes, arranging transportation, and providing counseling and support throughout the program and afterward to improve health outcomes.
Participants will be asked to select one Medicare benefit (DSMT, HBAI, or CCM) as their primary area of concentration for working toward reimbursement. Those who select DSMT will focus on utilizing the Diabetes Self-Management Program (DSMP), originally developed by Stanford University, as the curriculum for their diabetes self-management education and support services (DSMES). Those who focus on HBAI or CCM will incorporate the Chronic Disease Self-Management Program (CDSMP), originally developed by Stanford University, or another CDSME program, such as the Chronic Pain Management, as a component of the Medicare benefit.
The MRLC experience will provide opportunities for peer-to-peer learning; mentorship from aging service professionals whose organizations have successfully achieved accreditation and reimbursement for CDSME services; and intensive and targeted support, training, and technical assistance from the National CDSME Resource Center. Findings will be documented and shared with the broader network of partners and used to inform future learning collaborative efforts.
Twelve months from May 2018 through April 2019
By April 30, 2019, participating organizations will achieve or make significant progress toward achieving Medicare reimbursement for their CDSME programs 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 organizational “stages of change:”
- An implementation plan in place with decisions made regarding the effort;
- Necessary partnerships established to implement the program and provide referrals;
- Changes focused on accreditation (for those who concentrate on DSMT), e.g., completing the application for accreditation and ultimately attaining AADE or ADA accreditation/recognition;
- Appropriate clinical supervision and oversight, including Medicare credentialing;
- 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 of a claim, and reimbursement; and
- A system for documenting and tracking the services that are provided.
Support from the National CDSME Resource Center
The MRLC is designed to create a rich learning environment in which participants work together with intensive support, training, and technical assistance from the National CDSME Resource Center, in collaboration with the Administration for Community Living. The Center will provide:
- An in-person kick-off orientation meeting, in conjunction with the annual NCOA Center for Healthy Aging Annual Meeting (May 2018), with webinar capability availability, if needed;
- Recommended readings and resources;
- Monthly learning sessions (conference call/webinar format) that provide subject matter expertise on select topics, while facilitating group discussions and peer-to-peer sharing;
- One-on-one technical assistance calls initially, at midpoint, as needed throughout the twelve-month period, and at the conclusion of the learning collaborative;
- Mentor calls every two months with mentorship from the technical assistance team and aging service professionals whose organizations have been successful in achieving AADE or ADA accreditation/recognition and Medicare reimbursement; and
- An online community for posting questions and sharing information and resources, as well as for tracking progress.
Up to 10 organizations will be selected to participate in the MRLC. These organizations are expected to:
- Participate in the in-person kick-off orientation meeting (webinar capability available);
- Participate in monthly learning sessions (call/webinar format);
- Review recommended readings and resources as they are provided;
- Assign a lead and a co-lead to coordinate the effort and to participate in the monthly learning sessions, mentor calls, and one-on-one technical assistance calls;
- Identify key partners to serve on the learning collaborative team and invite them to join the monthly calls;
- Complete a Readiness Review to identify your organization’s degree of readiness to achieve the learning collaborative aims;
- Collaborate with your team to develop Aim Statements and an Action Plan with measurable goals and objectives;
- Work closely with your partners to carry out the necessary action steps to achieve the aims, including homework assignments;
- Provide monthly progress reports via the online community;
- Share challenges, progress, and lessons learned and be willing to serve as a mentor to support participants in the next generation learning collaborative.
Recommended Readings to Get Started
NCOA’s Community Integrated Health Care Toolkit, Medicare Opportunities – Under Learn the Basics, app participants should read Understanding Medicare and Medicare Part B and CDSME. Under Make It Happen, participants should familiarize themselves with the section that relates to their primary area of concentration. Please pay special attention to Tip Sheets, Information Resources, the ACL DSMT Toolkit (for those focused on DSMT), and FAQs.
Please contact Katie Zuke at firstname.lastname@example.org with any questions regarding this charter or the associated application.