September 11, 2013

New Law Helps Residents of Assisted Living Facilities with Diabetes

by Levin & Perconti

A news release issued by the National Community Pharmacy Association notes that a new law has been proposed which would aid Medicare beneficiaries to get diabetic testing supplies that are residents of assisted living facilities and who are homebound. The Diabetic Testing Supply Access Act (H.R. 2845), allows community pharmacies to provide same-day delivery services of diabetes testing supplies to residents of assisted living facilities or those who receive long-term care.

The new law was put forward in response to a ban on diabetic testing supply deliveries by community pharmacies which went into effect on July 1, 2013. This ban was created when the Centers for Medicare and Medicaid Services (CMS) implemented a national mail order program which prevented senior citizens who live at assisted living facilities from getting diabetic testing supplies from community pharmacies. CMS instituted the new policy in order to prevent large drug suppliers from getting around the mail order process for shipping the supplies in order to receive high reimbursements. The ban incorporated uniform payment rates for both retail and mail-order pharmacies.

Widespread criticism of the ban centered on concern that elderly people with diabetes living in assisted living facilities would no longer be able to get the benefits of face-to-face counseling and adherence services that are offered by community pharmacies that deliver diabetic testing supplies. There were also concerns expressed by many people in the healthcare industry that the ban would leave diabetic residents in assisted living facilities without the means for self-monitoring of glucose. Many small pharmacies expressed concern that because of the ban, many diabetic patients would be forced to switch to lower-quality products in order to monitor their diabetes. The ban put the health of many diabetic residents of assisted living facilities in jeopardy because they rely on small pharmacies to provide face-to-face consultation to make sure that are using their blood glucose monitoring devices correctly and that the results that the devices give are being interpreted correctly.

The new proposed law was introduced by U.S. Congressman Peter Welch of Vermont after many residents of assisted living facilities sent in complaints about the new CMS policy. Many of the complaints were based on the fact the new policy made it burdensome on caregivers at assisted living facilities to make sure that all diabetic residents had their glucose monitoring supplies. Many caregivers at these facilities noted that after the new CMS policy was enacted, some diabetic residents were not notified of the changes by Medicare and were left without supplies. The new proposal was spurred by the actions of Senator Welch and forty-three members of Congress, including U.S. Representative Aaron Schock of Illinois, who sent a letter to CMS in May questioning the prohibition on community pharmacy delivery of diabetic supplies.

Diabetes Monitoring and Assisted Living Facilities

Diabetics who live in assisted living facilities and nursing homes must constantly monitor their blood sugar every day through a variety of methods because having a safe blood sugar level is very crucial to their physical health. Depending on blood glucose test results, people with diabetes may need to act accordingly to bring their blood sugar levels under control. Caregivers in assisted living facilities must assist with treatments that may include insulin shots, eating, or drinking. Most assisted living facilities have an RN in the building at all times. The RN may be required to act on written orders from a diabetic resident’s doctor to manage the diabetes and this new legislation will aid staff in assisted living facilities with these tasks.

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