HB 5580, An Act Concerning Medicaid Coverage For Diabetes Prevention, Education And Self-Management Programs And Medical Nutrition Therapy

TESTIMONY OF THE CONNECTICUT HOSPITAL ASSOCIATION
SUBMITTED TO THE HUMAN SERVICES COMMITTEE

Thursday, February 20, 2025

The Connecticut Hospital Association (CHA) appreciates this opportunity to submit testimony concerning HB 5580, An Act Concerning Medicaid Coverage For Diabetes Prevention, Education And Self-Management Programs And Medical Nutrition Therapy. CHA supports this bill.

Connecticut hospitals and health systems care for patients, strengthen the state’s economy, and support vulnerable communities across the state. Every day, they work to improve healthcare access, affordability, and health equity. Even as they face ongoing challenges, hospitals provide world-class care to everyone who walks through their doors, regardless of their ability to pay. Hospitals also support an exemplary workforce as the largest collective employer in the state, contribute significantly to the state’s economy, and invest in their communities addressing social drivers of health.

HB 5580 seeks to provide Medicaid coverage for diabetes prevention, education, and self-management programs, and medical nutrition therapy in Connecticut. Connecticut’s Medicaid program currently covers nutrition counseling when medically necessary and ordered by an approved provider in the Connecticut Medical Assistance Program which excludes coverage of services provided by independent registered dieticians.¹

In the United States, Diabetes Mellitus is one of the top chronic diseases contributing to high healthcare utilization and healthcare spending overall. According to the American Diabetes Association, the burden of disease in Connecticut is that 33.1% of the adult population have prediabetes, 9.3% have diagnosed diabetes, and the total direct medical expenses for people with diabetes is 2.3 times higher than those who do not have diabetes.²

Although nutrition counseling services offer a broader range of dietary guidance that addresses general dietary concerns, evidenced-based comprehensive management such as Diabetes Self-Management Education and Support (DSMES) and Medical Nutrition Therapy (MNT) have been proven to help patients manage their disease effectively and prevent utilization. DSMES programs provide education on managing diabetes, medication, healthy eating, and physical activity. MNT offers a more intensive, personalized approach with dietary advice from a registered dietician to help patients manage their diabetes through proper nutrition. Connecticut patients with diabetes who have Medicare or a state-regulated plan coverage have access to DSMES and MNT services. This bill would extend this evidence-based coverage to Medicaid patients as well.

Effective coordination between primary care providers and certified diabetes educators and registered dieticians is important for comprehensive diabetes management. An increase in Medicaid reimbursement for providers will support integration of DSMES and MNT into primary care settings. However, even with coverage, barriers exist. Results of a DSMES analysis by the Connecticut Department of Public Health using All Payer Claims Data (APCD) indicated participation rates are low.3 Some barriers to participation include lack of awareness by individuals with diabetes and the limited reimbursement of care coordination support to ensure patients follow through on physician referrals to DSMES and MNT services.

Community-based community health workers (CHW) trained in diabetes education can provide targeted support to high-risk populations (i.e., those with uncontrolled diabetes) to help address specific barriers to their engagement with DSMES and MNT services. We recommend that the Connecticut Department of Social Services (DSS) also implement coverage for certified CHWs for care coordination support, which was previously authorized in statute.

Thank you for your consideration of our position. For additional information, contact CHA Government Relations at (203) 294-7301.

¹ https://www.huskyhealthct.org/members/Member%20PDFs/HUSKY_ACD_Covered_Services_Benefit_Grid.pdf
² https://diabetes.org/sites/default/files/2023-09/ADV_2023_State_Fact_sheets_all_rev_Connecticut.pdf