Ohio�s Diabetes Cost Reduction Act:
Frequently Asked Questions

1. Is Ohio alone in considering the Diabetes Cost Reduction Act?
   
   

   Not at all! As of today, 46 other states have found the cost-saving evidence so compelling that they have passed legislation similar to the Ohio Diabetes Cost Reduction Act.

   Furthermore, among the provisions designed to reduce Medicare spending in the federal budget agreement of October, 1997, the United States Congress included expanded coverage of diabetes education and diabetes supplies. These provisions had strong bipartisan support. In fact, both President Bill Clinton and House Speaker Newt Gingrich agreed that these Medicare provisions were necessary to control Medicare costs!

2. Won�t requiring coverage of diabetes medications, supplies and education raise the cost of health insurance?
   
   

   There is absolutely no evidence that this has happened in the 46 other states that have passed such legislation, even though several states have had the legislation for more than 10 years. In fact, there is increasing evidence that providing everything that people need to keep diabetes in control is reducing health insurance costs.

3. Why is a mandate necessary?
   
   

   The high cost of diabetes complications is a major public health problem. A mandate is necessary to protect the public from unnecessary disease, disability, and death and from the excessive expense of preventable diabetes complications.

   The Diabetes Cost Reduction Act would ensure that people with diabetes could get the medically necessary supplies and self-management education for long-term management of this chronic disease. Private insurance coverage is now voluntary. Many health plans in Ohio do not cover these items. Many people with diabetes cannot afford to pay for the medically necessary supplies and self-management education needed to control their diabetes. As a result, over the long term, they develop the devastating, expensive, and preventable complications of uncontrolled diabetes�amputations, blindness, heart attacks, kidney failure, and strokes.

4. Is providing diabetes supplies and self-management education cost-effective?
   
   

   Providing diabetes supplies and self-management education is necessary for good diabetes control. Many scientific studies and numerous other reports by governmental agencies have shown that good diabetes control prevents expensive, disabling, long-term diabetes complications. Furthermore, good diabetes control also results in short-term benefits of fewer Emergency Room visits, fewer sick days, and greater productivity on the job for working-aged people.

5. Is there a "gatekeeper" to make sure the supplies and services are used appropriately?
   
   

   The Diabetes Cost Reduction Act requires that diabetes supplies and self-management education must be prescribed by a health care professional who is licensed to prescribe such items.

6. Why not "spell out" in the law what supplies are covered � for example, test strips, syringes, insulin pumps, etc.
   
   

   We know what supplies are needed today, but in the future, new technology may make these obsolete, and other supplies may be needed.

7. How will excess utilization of the education benefits be reasonably controlled?
   
   

   Throughout the U.S. in the 46 states that already require provision of diabetes self-management education, excess utilization has not been a problem. Furthermore, excess utilization has not been a problem under Medicare or Medicaid. However, because this is a concern of Ohio State Legislators, the current bill specifies that insurers are required to cover the same number of hours of diabetes self-management education as are covered under Medicare.

8. What are the qualifications of persons providing diabetes self-management education?
   
   

   Licensed health care professionals with expertise in diabetes care � dieticians, nurses, physicians, or pharmacists.

9. Why not specify a Certified Diabetes Educator (CDE) as the person providing diabetes self-management education?
   
   

   The CDE is a desirable credential that demonstrates expertise in diabetes care. However, in some areas of Ohio, professionals with this credential may not be available to serve people who need diabetes self-management education.

10. Why not specify that all education will take place in a group setting?
    
    

    Some aspects of diabetes self-management education must be taught one-to-one to be effective. Examples include medical nutrition therapy (planning meals according to medical need), and self-administration of insulin. Other aspects can be taught in a group setting. Examples include principles of foot care, when to handle a problem at home vs. when to call a doctor, planning for safe and appropriate exercise.

11. What is Medical Nutrition Therapy, and why is it needed?
    
    

    Medical Nutrition Therapy is planning meals and snacks according to medical need for specific nutrients. It is an essential component of the medical treatment for all persons with diabetes. It may be all that is needed for some persons to control their diabetes and prevent complications.

12. Why does the Ohio Diabetes Cost Reduction Act state that Medical Nutrition Therapy will be provided by a licensed dietitian?
    
    

    The dietitian is the licensed professional with expertise in Medical Nutrition Therapy, and should therefore have primary responsibility in this area. Other members of the diabetes treatment team (nurse, pharmacist, and physician) should re-enforce the dietitian�s instruction.

13. Why not specify that diabetes self-management education is only for persons who have been newly diagnosed?
    
    

    Throughout a lifetime with this chronic disease, an individual�s medical condition and life circumstances change. Furthermore, medical advances are changing diabetes treatments, and more effective treatments are becoming available. All of these changes make periodic updates necessary for all people with diabetes, even those who have had excellent self-management education in the past. In addition some people with long-standing disease never received self-management education, or never understood it. These people can still benefit from learning to avoid diabetes complications.

14. Would home visits be included?
    
    

    This option would be available by prescription for people who are home bound, and would therefore be unable to receive diabetes education without home visits.

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