1. Clinic Waiting Room Diabetes Education Video Project Critical Access Hospital (CAH) Diabetes Webcast July 29,2015 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 Critical Access Hospital (CAH) Diabetes Webcast Objective The objective of this Webcast is to increase the awareness of the problem that diabetes presents in critical access hospitals 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 Critical Access Hospital (CAH) Diabetes Webcast Panelists Cindy Finley, RN, BSN, Iron County Medical Center 301 N Highway 21 Pilot Knob, MO 63663

4. Clinic Waiting Room Diabetes Education Video Project Critical Access Hospital (CAH) Diabetes Webcast Panelists Nickolas Clasen, BS Regional External Affairs Centers for Medicare & Medicaid Services (CMS) 601 East 12 th Street Kansas City, MO 64106

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 601 East 12 th Street Kansas City, MO 64106

6. Clinic Waiting Room Diabetes Education Video Project Critical Access Hospital (CAH) Diabetes Webcast Objective The objective of this Webcast is to increase the awareness of the problem that diabetes presents in critical access hospitals 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 Critical Access Hospital (CAH) 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 Critical Access Hospital (CAH) 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 Critical Access Hospital (CAH) 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 Critical Access Hospital (CAH) 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 Critical Access Hospital (CAH) 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 Critical Access Hospital (CAH) Diabetes Webcast Cindy Finley, RN,BSN Iron County Medical Center 301 N Highway 21 Pilot Knob, MO 63663

14. There is a prevalence of diabetes. According to the Missouri Department of Health and Human Services, in southeast Missouri, 12.7% of the population currently has diabetes¹ This is compared to a 9.6% average prevalence within the state of Missouri¹ In addition, according to the U. S. Department of Health, only 12% of the population in our country has proficient health literacy ² Input on 14 videos from the National Diabetes Education Program (NDEP)³

15. Diabetes education is an important part of a patient’s visit These videos can help to provide reinforcement to diabetes education Waiting room time is often wasted time

16. This video project will provide a way to capture and teach those individuals who are not picking up the pamphlets on the tables—the ones who are taking those printed education documents and “filing” them as soon as they leave the office The National Diabetes Education Program has provided valuable information in these short videos Great advantage to patients having the opportunity to view these videos in the waiting room prior to their visit

17. The subjects in these videos are regular people who are dealing with the issues that diabetes places in their lives. The patient populations in Missouri and Kansas will identify with the patients in these short, informative videos Healthcare in this country is changing. It’s challenging. It’s expensive

18. The Affordable Care Act has required all insurance carriers to provide preventive health services to patients at no cost Something as small as a video loop playing in a waiting room can go a long way in educating, prompting questions, and even motivating patients. It’s a win-win for both patients and providers

19. References ¹Retrieved from Missouri Department of Health and Senior Services, http://health.mo.gov/data/communitydataprofiles/ on June 14, 2015 http://health.mo.gov/data/communitydataprofiles/ ² Retrieved from U.S. Department of Health and Human Services, http://www.health.gov/communication/literacy/issuebrief on June 30, 2015 http://www.health.gov/communication/literacy/issuebrief ³Retrieved from National Diabetes Education Program, http://ndep.nih.gov/index.aspx on June 14, 2015 http://ndep.nih.gov/index.aspx

20. Cindy Finley, RN,BSN Iron County Medical Center 301 N Highway 21 Pilot Knob, MO 63663 cfinley@icmedcenter.org

21. 2015 Centers for Medicare & Medicaid Services: Preventive Benefits - Coverage of Diabetic Services and Supplies

22. 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 Supplies22

23. 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 23 05/01/2015

24. 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 Supplies24

25. 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 25

26. 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 Supplies26

27.  In March 2010, President Obama signed the Affordable Care Act into law generally requiring: February 2015Marketplace 10127 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

28.  In March 2010, President Obama signed the Affordable Care Act into law generally requiring: February 2015Marketplace 10128 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

29. February 2015Marketplace 10129 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)

30. February 2015Marketplace 10130 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

31. February 2015Marketplace 10131 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

32. February 2015Marketplace 10132 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