IT'S OFFICIAL!  

     The Balanced Budget Act of 1997, (BBA Provisions 4105) expanded Medicare coverage of home blood glucose monitors and related accessories to include Type II diabetics. (those not treated with insulin)  Previously, Medicare only covered supplies for those diabetics that were insulin-treated. (Type I)  The expanded benefit took effect July, 1, 1998

     If you are a Type II or Type I diabetic, call Diabetes Home Care at 1-800-544-5433 for more information on how you can qualify for these services.

How Do I Qualify?
     Medicare pays for blood glucose monitors and test strips if the physician treating the beneficiary's diabetic condition documents that the beneficiary or care giver is capable of being trained to use the monitor and the monitor is designed for home use. (Most monitors are designed for this purpose and simple to operate.) All applicable Medicare deductibles and co-payments will apply to these benefits.

Test Strips and Lancets for Insulin-Treated Diabetes- Medicare will pay for up to 100 test strips and 100 lancets every month for use by a beneficiary who is an insulin treated diabetic. Medicare will pay for more than 100 test strips and lancets per month if the physician documents the beneficiary's need to test blood sugars more often.

Test Strips and Lancets for Non-Insulin-Treated Diabetes- Medicare will pay for up to 100 test strips and 100 lancets every three months for use by the beneficiary. Medicare wil pay for more than 100 test strips and lancets every two months for non-insulin-treated beneficiaries if one of the following indicators is present:

-Management of medical condition by adjusting therapy and/or oral agents; or
-Detection of hypoglycemia when symptoms are present.

How do I get started?

     Just call Diabetes Home Care. 800-544-5433

     Our friendly staff will help determine your coverage and assist you in obtaining the proper documentation for coverage.

     If your physician is treating your diabetes and feels you would benefit from home blood glucose monitoring, or you are currently monitoring your blood sugar and paying out-of-pocket for your supplies, we can help you get the supplies you need covered and bill Medicare for you.

Here's a Legislative summary of the new law:

Balanced Budget Act Of 1997 Medicare and Medicaid Provisions

Diabetes Self Management (Section 4105)

Provisions

     Provides coverage for diabetes outpatient self-management training to include services furnished in non-hospital-based programs (already covered in hospital based programs.) Services  may be provided  by  physicians or other entities designated by the Secretary it they also provide other services paid by Medicare and meet quality standards established by the Secretary. A physician managing the patient's condition must certify that the services are needed under a comprehensive   plan of care. Services will be paid under the physician fee schedule in amounts set by the Secretary in consultation with appropriate organizations.

Provides coverage for blood glucose monitors and testing strips for all diabetics (already covered for insulin-dependent diabetics). Payment for testing strips used with blood glucose monitors will be reduced by 10 percent.

Requires the Secretary to establish outcomes measures for evaluating improvements in the health status of Medicare beneficiaries with diabetes, and to periodically submit recommendations to Congress on modifications to coverage of services for diabetics.

Effective Date: