1. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast July 22,2015 CAPT Dave Ellison, R.Ph., MPA Area/Regional Pharmacy Officer U.S. Department of Health and Human Services Health Resources and Services Administration Office of Regional Operations Kansas City Regional Division

2. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast Objective The objective of this Webcast is to increase the awareness of the problem that diabetes presents in Rural Health clinics in Kansas and Missouri; and to present the Clinic Waiting Room Diabetes Education Video Project as a tool that can help with patient literacy regarding diabetes.

3. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast Panelists Diane Rowe, RN, MSN, FNP-C, Diabetes Educator Elk River Health Services, INC, Anderson, MO

4. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast Panelists Nickolas Clasen, BS Regional External Affairs Centers for Medicare & Medicaid Services (CMS) Kansas City, MO

5. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast Panelists CAPT Dave Ellison, R.Ph., MPA Area/Regional Pharmacy Officer HRSA, Office of Regional Operations Kansas City Regional Division Kansas City, MO

6. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast Objective The objective of this Webcast is to increase the awareness of the problem that diabetes presents in rural health clinics in Kansas and Missouri; and to present the Clinic Waiting Room Diabetes Education Video Project as an additional tool that can help with patient literacy regarding diabetes. The tool must: Be evidence based Identify a pre-developed source for a diabetes education video Have input from intended users

7. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast Diabetes Surveillance Diabetes is the leading cause of kidney failure, lower-limb amputations other than those caused by injury, and new cases of blindness among adults.¹ Research has found that rural diabetics are less likely to receive certain types of care, such as eye and foot examinations and diabetes education.² The percent of adults with undiagnosed diabetes in Kansas is 9.5%. ³ 9.8% of Missouri adults have diabetes.⁴

8. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast Source for videos to develop the video loop is the National Diabetes Education Program (NDEP) (sponsored by the National Institutes of Health and the Centers for Disease Control)⁵ Message that the Affordable Care Act covers preventative health services for adults, women, and children (at no cost to the patient) including Diabetes (Type 2) screening and Diet Counseling for adults – has been included This video presents an alternative (via waiting room exposure) to help raise the rural patient health literacy regarding diabetes

9. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast The information included in this video is provided by the National Diabetes Education Program (NDEP), which is sponsored by the Department of Health and Human Services (DHHS), the National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC). The sole purpose of this video is to help raise Health Literacy regarding Diabetes and to increase awareness of the NDEP as another tool to help address Diabetes.

10. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast The information included in this video is provided by the National Diabetes Education Program (NDEP), which is sponsored by the Department of Health and Human Services (DHHS), the National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC). The sole purpose of this video is to help raise Health Literacy regarding Diabetes and to increase awareness of the NDEP as another tool to help address Diabetes. Additionally, it is important to note that preventive health services for adults, women, and children are covered by the Affordable Care Act – at no cost to the patient. These covered preventive health services include Diabetes (Type 2) screening and Diet counseling among the 63 covered preventive services. Please go to https://www.healthcare.gov/preventive-care-benefits for full information regarding these covered services for Affordable Care Act enrollees.https://www.healthcare.gov/preventive-care-benefits

11. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast REFERENCES ¹Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2011. Atlanta, GA: Centers for Disease Control and Prevention, US Dept. of Health and Human Services;2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs 2011.pdf (http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf) Accessed December 20, 2013. ²Krishna, S., Gillespie, K. N., & McBride, T. M. (2010). Diabetes burden and access to preventative care in the rural United States. Journal of Rural Health. 26(1),3-11. Accessed August 16, 2013. from http://onlinelibrary.wiley.com/doi.10.1111/j.1748- 0361.2009.00259.x/abstract:jsessionid=D99AD3AB6618092D6190FE85B5D63290.f03t04. doi:10.1111/j.1748- 0361.2009.00259xhttp://onlinelibrary.wiley.com/doi.10.1111/j.1748- 0361.2009.00259.x/abstract:jsessionid=D99AD3AB6618092D6190FE85B5D63290.f03t04 ³Kansas Department of Health and Environments, Kansas Health Matters, http://www.kansashealthmatters.org/modules.php?op=modload&name=NS- indicator&file=indicator&lid=17325464 Last Updated 2015. http://www.kansashealthmatters.org/modules.php?op=modload&name=NS- indicator&file=indicator&lid=17325464 ⁴U.S. Department of health and Human Services, Centers for Disease Control and Prevention. (2011). National diabetes fact sheet: National estimates and general information on diabetes and prediabetes in the United States. Accessed August 16, 2013, from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf ⁵National Diabetes Education Program (NDEP) Diabetes Videos. Accessed May 30, 2015 from http://ndep.nih.gov/resources/index.aspx?ToolType=17 http://ndep.nih.gov/resources/index.aspx?ToolType=17

12. Contact Information CAPT Dave Ellison, R.Ph., MPA Area/Regional Pharmacy Officer 601 East 12 th Street, Room 250 Kansas City, MO 64106 (816) 426-5297 dellison@hrsa.gov

13. Clinic Waiting Room Diabetes Education Video Project Rural Health Clinic (RHC) Diabetes Webcast Diane Rowe, RN, MSN,FNP-C Elk River Health Services, INC 104 E Main Street, Anderson, MO 64831

14. 05/01/2015Advanced Diabetic Supplies14 Confirmed diabetes in the Elk River Health Services Areas is 11.5% of the population¹ In the Kansas county where I attended school diabetes is 12.5%² Estimates of 20.1 million people have diabetes and there are an estimated 8.1 million that are undiagnosed³ 24% of all Americans receive their healthcare in rural health setting⁴

15. There is a 17% higher number of the population in rural America than compared to the urban population⁵ Healthy people 2010 views the Diabetes issue to be one of such significance that it is one of the top three priorities for rural health areas⁶ According to the National Institute of Health Office of Behavioral and Social Health Services Research, low health literacy affects about 90 million people or about 43% of people who have poor or below level literacy⁷ HealthEd Academy LLC cites that due to low health literacy and anxiety patients only recall about 50% of what they learned in their office visit⁸

16. References ¹⁺² Retrieved online from http://www.cdc.gov/diabetes/atlas/countydata/atlas.html http://www.cdc.gov/diabetes/atlas/countydata/atlas.html on May 17, 2015 ³Retrieved online from http://www.cdc.gov/diabetes/pubs/statsreport14/national- diabetes-report-web.pdf on May 17, 2015 http://www.cdc.gov/diabetes/pubs/statsreport14/national- diabetes-report-web.pdf ⁴⁺⁵Retrieved online from http://www.ruralhealthweb.org on May 25, 2015http://www.ruralhealthweb.org ⁶Retrieved online from http://clinical.diabetesjournals.org/content/28/1/20.full on May 17, 2015 http://clinical.diabetesjournals.org/content/28/1/20.full ⁷Retrieved on line from http://obssr.od.nih.gov/scientific areas/social culture factors in health/health literacy/index.aspx on May 27, 2015http://obssr.od.nih.gov/scientific areas/social culture factors in health/health literacy/index.aspx ⁸Retrieved from https://healthedacademy.com/Report.aspx on May 17, 2015https://healthedacademy.com/Report.aspx

17. Diane Rowe, RN, MSN,FNP-C Elk River Health Services, INC 104 E Main Street, Anderson, MO 64831

18. 2015 Centers for Medicare & Medicaid Services: Preventive Benefits - Coverage of Diabetic Services and Supplies

19. Medicare Coverage of Preventive Benefits Diabetes Coverage Medicare enacted in 1965 The Balanced Budget Act of 1997 (BBA) The Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) The Affordable Care Act of 2010 (ACA) 05/01/2015Advanced Diabetic Supplies19

20. Medicare Coverage for Diabetes Supply/serviceWhat’s coveredWhat you pay Anti-diabetic drugsPart D covers anti-diabetic drugs for maintaining blood sugar (glucose). Coinsurance or copayment ; Part D deductible may also apply Diabetes screenings Hemoglobin A1c Tests Part B covers these screenings if your doctor determines you’re at risk for diabetes. You may be eligible for up to 2 diabetes screenings each year. No coinsurance, copayment, or Part B deductible; Generally, 20% of the Medicare-approved amount for the doctor’s visit Diabetes self-management training Part B covers outpatient training for people at risk for complications from diabetes or recently diagnosed with diabetes to teach them to manage their diabetes, with a written order to a certified diabetes self-management education program. 20% of the Medicare- approved amount after the yearly Part B deductible Advanced Diabetic Supplies 20 05/01/2015

21. Diabetic Equipment and Supplies Supply/serviceWhat’s coveredWhat you pay Diabetes equipment & supplies Uses insulin, they may be able to get up to 300 test strips and lancets every month, and 1 lancet device every 6 months. Does not use insulin, they may be able to get 100 test strips and lancets every 3 months, and 1 lancet device every 6 months. Blood glucose self-testing equipment and supplies are covered for all people with Medicare Part B who have diabetes. These supplies include: Blood glucose monitors; Blood glucose test strips; Lancet devices and lancets; Glucose control solutions for checking the accuracy of testing equipment and test strips. 20% of the Medicare- approved amount after the yearly Part B deductible If your doctor says it’s medically necessary, Medicare will allow you to get additional test strips and lancets. Diabetes suppliesPart D covers certain medical supplies for administration of insulin (like syringes, needles, alcohol swabs, gauze, and inhaled insulin devices). Coinsurance or copayment Part D deductible may also apply 05/01/2015 Advanced Diabetic Supplies21

22. Foot Exams and Therapeutic Shoes or Inserts Supply/serviceWhat’s coveredWhat you pay Foot exams & treatmentPart B covers a foot exam every 6 months for people with diabetic peripheral neuropathy and loss of protective sensation, as long as they haven’t seen a foot care professional for another reason between visits. 20% of the Medicare- approved amount after the yearly Part B deductible Therapeutic shoes or insertsPart B covers therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease. The doctor must certify your need for therapeutic shoes or inserts. The shoes and inserts must be prescribed and provided by a qualified doctor. 20% of the Medicare- approved amount after the yearly Part B deductible 05/01/2015 Advanced Diabetic Supplies 22

23. Insulin, Pumps and Medical Nutrition Supply/serviceWhat’s coveredWhat you pay InsulinMedicare Part D covers insulin that isn’t administered with an insulin pump. Coinsurance or copayment Part D deductible may also apply Insulin pumpsMedicare Part B covers external insulin pumps and the insulin that the device uses under durable medical equipment for people who meet certain conditions. 20% of the Medicare- approved amount after the yearly Part B deductible Medical Nutrition TherapyPart B may cover medical nutrition therapy and certain related services if you have diabetes or kidney disease, and your doctor refers you for the service. No copayment, coinsurance, or Part B deductible if your doctor or health care provider accepts assignment 05/01/2015Advanced Diabetic Supplies23

24.  In March 2010, President Obama signed the Affordable Care Act into law generally requiring: February 2015Marketplace 10124 The Health Care Law Insurers can no longer deny health insurance coverage because of a pre-existing condition Young adults up to 26 can stay on their parents’ plan Additional drug coverage for people with Medicare More preventive services with no cost-sharing Lifetime limits removed from essential health benefits And many additional consumer protections As well as the Health Insurance Marketplace

25.  In March 2010, President Obama signed the Affordable Care Act into law generally requiring: February 2015Marketplace 10125 The Health Care Law Insurers can no longer deny health insurance coverage because of a pre-existing condition Young adults up to 26 can stay on their parents’ plan Additional drug coverage for people with Medicare More preventive services with no cost-sharing Lifetime limits removed from essential health benefits And many additional consumer protections As well as the Health Insurance Marketplace

26. February 2015Marketplace 10126 Qualified Health Plans Cover Essential Health Benefits  Essential health benefits include at least these 10 categories Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care (pediatric oral services may be provided by stand-alone plan)

27. February 2015Marketplace 10127 The Affordable Care Act Free Preventive Services Applies only when these services are delivered by a network provider: Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked Alcohol Misuse screening and counseling Aspirin use to prevent cardiovascular disease for men and women of certain ages Aspirin use Blood Pressure screening for all adults Blood Pressure screening Cholesterol screening for adults of certain ages or at higher risk Cholesterol screening Colorectal Cancer screening for adults over 50 Colorectal Cancer screening Depression screening for adults Depression screening Diabetes (Type 2) screening for adults with high blood pressure Diabetes (Type 2) screening Diet counseling for adults at higher risk for chronic disease Diet counseling

28. February 2015Marketplace 10128 The Affordable Care Act Free Preventive Services This applies only when these services are delivered by a network provider: Hepatitis C screening for adults at increased risk, and Hepatitis C screening one time for everyone born 1945 – 1965 HIV screening for everyone ages 15 to 65, and other ages at increased risk HIV screening Immunization vaccines for adults — doses, recommended ages, and recommended populations vary: Immunization vaccines Lung cancer screening for adults 55 - 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years Lung cancer screening Obesity screening and counseling for all adults Obesity screening and counseling Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk Sexually Transmitted Infection (STI) prevention counseling Syphilis screening for all adults at higher risk Syphilis screening Tobacco Use screening for all adults and cessation interventions for tobacco users Tobacco Use screening

29. February 2015Marketplace 10129 The Affordable Care Act Coverage Related to Diabetic Risk Diabetes screening for adults with high blood pressure Diet counseling for adults at higher risk for chronic disease