Survey Report: Where are they now? 2016 and 2017 Medicare Reimbursement Learning Collaborative Participants


The purpose of this Learning Collaborative (LC) is to achieve integrated, sustainable service systems for Chronic Disease Self-Management Education programs by supporting state and community-based organizations as they work to obtain reimbursement for CDSME services provided under the Medicare Health and Behavior Assessment and Intervention (HBAI) benefit.

Over a period of ten months, LC participants will have an opportunity to learn from their peers, while receiving enhanced support from the CDSME Resource Center and guidance from subject matter experts. Learnings from this experience will be documented and shared with others to inform their sustainability efforts.


Ten months from January – October 2016


By October 31, 2016, participating organizations will have achieved or made significant progress toward achieving the following:

  • An infrastructure in place to meet the minimum clinical oversight requirement to provide HBAI services;
  • Written organizational policies and procedures established to assure that all billing, coding, assessment, intervention, and documentation requirements for the HBAI benefit are met, while maintaining the fidelity of the CDSME program;
  • A Medicare provider number or an agreement in place with a Medicare provider that will partner in the delivery and billing of the HBAI benefit; and
  • A referral, documentation, billing, and tracking system in place.

Support from the National CDSME Resource Center

The Center, in collaboration with ACL, will support participants throughout the LC experience in the following ways:

  • Provide orientation and offer online trainings;
  • Host monthly conference calls to provide peer-to-peer learning and make subject matter experts available during each call to facilitate learning;
  • Moderate an online community to facilitate sharing of best practices and resources, foster peer-to-peer
    support, and provide technical assistance; and
  • Host an in-person LC meeting in conjunction with the annual Resource Center meeting (May 24-
    26, 2016).

Participant Expectations

Participants are expected to:

  • Identify key partners to participate in a HBAI LC team;
  • Become familiar with the readings below, as well as other community-integrated health care resources on NCOA’s website;
  • Complete an assessment to identify the stage of readiness to bill for HBAI services;
  • Collaborate with their LC team to develop measurable goals and objectives to achieve the LC aim;
  • Attend the orientation and online trainings;
  • Participate in all monthly calls;
  • Participate in the HBAI online community;
  • Work closely with their partners to plan and implement the project;
  • Carry out the actions described in the HBAI Tip Sheet (see readings below);
  • Develop written organizational policies and procedures to meet all HBAI requirements;
  • Apply for a Medicare provider number or establish an agreement with a Medicare provider;
  • Develop referral, billing, documentation, and tracking processes for HBAI services;
  • Report on progress; and
  • Share lessons learned.