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Federal officials are contemplating the expansion of Medicare medical nutrition therapy (MNT) coverage to beneficiaries with pre-diabetes, sources tell DOC News. Coverage currently is available to patients diagnosed with type 2 diabetes.
Since January 1, 2002, MNT by a registered dietitian or nutrition professional has been included as a benefit for patients with diabetes or renal disease under Medicare Part B. The MNT benefit includes a maximum of 3 hours of MNT services within 12 months of the initial assessment, and 2 hours per year in subsequent years.
Although expansion of benefits is good news for the 40% of people with diabetes who are over 65 years of age, many in the field contend that a greater payoff could be realized by extending MNT services to people with pre-diabetes to inhibit the development of full-blown disease.
According to an analysis commissioned by the American Dietetic Association, patients with diabetes using dietitian services had 9.5% fewer hospital admissions and 23.5% fewer physician visits. For patients with cardiovascular disease, dietitian services were associated with an 8.6% reduction in hospitalization and a 16.9% reduction in doctor visits.1
"I really think that [Medicare coverage of MNT] is going to happen very soon," said Charlene Postigo, business services manager of Park Nicollet Institute in Minneapolis, at a session on billing and coding at the annual meeting of the American Association of Diabetes Educators, held August 10–13 in Washington, D.C.
ACTION IN CONGRESS
Although rumors suggest that Medicare is about to extend MNT coverage to pre-diabetes, the Centers for Medicare and Medicaid Services (CMS) says it cannot make such a move without authorization from Congress.
"We are not currently working on expanding medical nutrition therapy to pre-diabetes," says a CMS spokesperson. "Our position is that this kind of benefit really requires specific congressional authorization. We're authorized to provide it for diabetes, but not pre-diabetes.
Bills to extend MNT to people with pre-diabetes have been introduced in both houses of Congress. Sen. Larry Craig (R-Ind.) in March introduced the Medicare Medical Nutrition Therapy Act of 2005 (S 604) "to amend title XVIII of the Social Security Act to authorize expansion of Medicare coverage of medical nutrition therapy services."
In April, Rep. Fred Upton (R-Mich.) introduced similar legislation (HR 1582) that would give the Secretary of Health and Human Services, acting through CMS, the authority to use the National Coverage Determination Process to expand coverage for other diseases and conditions "for which these services would be both beneficial and cost-effective," Upton said when introducing his bill.
In response to a request in the 1997 Balanced Budget Act to study the value of adding MNT coverage to the Medicare program, Upton reports that the Institute of Medicine concluded this coverage would "improve the quality of care and is likely to be a valuable and efficient use of Medicare resources, because of the comparatively low treatment costs and ancillary benefits associated with nutrition therapy."
With support for the measure growing in both political parties, sources familiar with the issue are confident that passage is imminent.
CMS added screening services for diabetes and cardiovascular disease as
Medicare benefits beginning in January 2005. All Medicare beneficiaries are
entitled to one annual diabetes screening test, while patients with
pre-diabetes are allowed two screening tests per year.
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