Legislation for Diabetes Benefits Coverage a National Perspective

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Legislation for Diabetes Benefits Coverage a
National Perspective

• Rui Li, M.D., Ph.D.
• Division of Diabetes Translation
• Centers for Disease Control and Prevention

DDT Conference 2008 Orlando, FL
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Disclaimer

• The findings and conclusions in this report are
  those of the authors and do not necessarily
  represent the views of the Centers for Disease
  Control and Prevention

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Outline

• History of legislation
• Contents of legislation
• State mandates
• Medicare
• Effects of legislation

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State Legislation
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History of Legislation
Alabama, Idaho, North Dakota, and Ohio havent
passed the mandates In these states, the laws
were effective later than October of the previous
year we coded the enactment year as the next
year.
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Contents of Legislation
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Effects of the Legislation
75
Unadjusted probability of U.S. adult diabetes
patients receiving diabetes preventive care
before and after state mandated coverage on
diabetes
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Probability of Receiving Daily Self-Monitoring of
Blood Glucose Before and After Legislation
Plt0.05 Plt0.01
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Probability of Receiving Annual Foot Exams
Before and After Legislation
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Probability of Receiving Annual Eye Exams Before
and After Legislation
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Probability of Receiving All Three Care Before
and After Legislation
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Medicare
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History and Coverage

• Expand self-management education classes to
  out-patient care (Aug. 1, 1998)
• Expand coverage of monitors and strips to
  non-insulin users (Aug. 1, 1998)
• Medical nutritional therapy (Jan. 1, 2002)
• Glaucoma screening (Jan. 1, 2002)
• Diabetes screening (Jan.1, 2005)

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Effects of Medicare Coverage
Li, et al. AJPH, 2008 Feb 98358-364
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Li, et al. AJPH, 2008 Feb 98358-364
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Conclusions

• State mandatory coverage of diabetes benefits had
  
• a moderate positive effect on SMBG and annual
  foot exams
• No significant effect on annual eye exams
• Medicare expansion on strips and monitors had a
  large positive effect on SMBG

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Comparison of the Legislation

• State Mandates
• Heterogeneous coverage
• Vague language
• May not publicizing and enforcement
• May lose insurance coverage

• Medicare expansion in 1997
• Uniform coverage
• Specific
• Publicizing and strong enforcement
• Can not phase out

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Similar Legislation on other Coverage

• State mandates on minimum hospital stay after
  C-session
• State mandates on Medicaid health care
  satisfaction

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Policy Implications

• Contents of legislation matters
• Passing legislation is only the first step
• Evaluation is necessary