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Conaway, Pinkin, Sumter & Wimberly Bill Requiring Medicaid to Cover Diabetes Education for Patients Clears Assembly

Legislation sponsored by Assembly Democrats Herb Conaway, Nancy Pinkin, Shavonda Sumter and Benjie Wimberly to educate Medicaid patients on diabetes and pre-diabetes care was approved Monday by the General Assembly.

The sponsors noted that diabetes is the sixth leading cause of death in New Jersey, and responsible for nearly 2,000 deaths each year, according the New Jersey Department of Health website. Approximately 700,000 state residents have diabetes.

“The financial costs and suffering caused by diabetes are increasing rapidly in New Jersey and nationwide,” said Conaway (D-Burlington). “By teaching residents how to take care of themselves, we can help them understand how to manage their diabetes and live well.”

The sponsors note that diabetes self-management training can reduce the costs and suffering associated with the disease by providing tips for eating healthy, being active, monitoring blood sugar, taking medication properly, and reducing risk.

“Self-management education programs have helped lower extremity amputation rates, reduce medication costs, and resulted in fewer emergency room visits and hospitalizations,” said Pinkin (D-Middlesex). “Education will save more lives in New Jersey as well as help residents coping with diabetes live their best lives.”

“A 2014 report projected the number of New Jersey residents with the disease would double by 2025,” said Sumter (D-Bergen/Passaic). “This disease can be devastating. It kills thousands in New Jersey each year. Educating residents on how to manage and live with diabetes can help them take control of the disease before they become another statistic.”

“Diabetes can wreak havoc on a person’s body, but with healthy eating, regular physical activity and proper medication, it can be managed. That is why education about how to treat it is key,” said Wimberly (D-Bergen/Passaic). “Teaching residents who are diabetic how to manage the disease and take better care of themselves can help them live healthier, longer lives.”

The bill (A-2993) would require Medicaid coverage to in-state providers for self-management education, training, services, and equipment for patients diagnosed with diabetes, gestational diabetes, and pre-diabetes.

Under the bill, the self-management education or training would have to be provided by: a health care professional who has been certified by the National Certification Board of Diabetes Educators or by the American Association of Diabetes Educators, including a physician, an advanced practice nurse or registered nurse, a pharmacist, a chiropractor, or a registered dietitian; or by an entity meeting the National Standards for Diabetes Self-Management Education and Support.

The bill would require Medicaid to cover expenses for in-state providers of medical nutrition therapy as a component of a patient’s overall treatment plan when: the person is diagnosed with diabetes, gestational diabetes, or pre-diabetes; there is a change in the person’s medical condition, treatment, or diagnosis; or when the health care provider determines that reeducation or refresher education is necessary. The bill would also require Medicaid to cover items and services furnished under a diabetes prevention program that meets the standards of the National Diabetes Prevention Program established by the Centers for Disease Control and Prevention for persons diagnosed with pre-diabetes.

Lastly, expenses for medically appropriate and necessary supplies and equipment recommended or prescribed for the management and treatment of diabetes, gestational diabetes, or pre-diabetes would also have to be covered by Medicaid under the bill.

The bill would limit coverage for the education, training, services, and equipment enumerated by the bill to persons diagnosed with diabetes, gestational diabetes, or pre-diabetes who have received a referral from a physician, advanced practice nurse, or physician assistant.

The bill would take effect immediately upon enactment.

The measure was approved by the Assembly Health and Senior Services Committee chaired by Conaway.