Index Manuals Report to Congress on Leveraging Federal Programs to Prevent and Control Diabetes and Its Complications (2021)
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2021
Recommendation 4.8: The National Clinical Care Commission recommends that all
federal agencies whose work influences the ambient (air, water, land, and chemical) and
built environments modify their policies, practices, regulations, and funding decisions so as
to lead to environmental changes to prevent and control diabetes.
•
4.8a. All federal agencies should limit the extent to which their work contributes
to individual-level and population-level exposure to environmental pollutants
and contaminants associated with diabetes and/or diabetes complications. The
Environmental Protection Agency should ensure that environmental protections
are in place to limit individual-level and population-level exposure and implement
abatement measures, prioritizing those exposures that contribute to diabetes-
related disparities.
•
4.8b. All federal agencies (in particular, the U.S. Department of Transportation
and the U.S. Department of Housing and Urban Development [HUD]) should
modify their policies, practices, regulations, and funding decisions related to the
built environment to prevent diabetes and diabetes complications by enhancing
increasing walkability, green space, physical activity resources, and active transport
opportunities. Priority should be given to those regions and projects that could
mitigate the effects of unhealthy built environments on diabetes-related disparities.
Recommendation 4.9: The National Clinical Care Commission recommends that, to
reduce type 2 diabetes incidence and diabetes complications, housing opportunities for
low-income individuals and families be expanded, and that such individuals and families be
housed in health-promoting environments.
•
4.9a. The U.S. Department of Housing and Urban Development (HUD) should
expand its federal housing assistance programs to allow access for more qualifying
families, such that over a 20-year period, all that qualify can access subsidized or
public housing.
•
4.9b. The Internal Revenue Service (IRS) should further incentivize developers to
place new housing units in areas of low poverty, as data show that moving people
from areas of high poverty to low poverty favorably affects the incidence of obesity
and diabetes.
•
4.9c. The IRS should mandate that states include neighborhood health parameters
(such as availability of health care services, transportation, employment
opportunities, education opportunities, food availability, and physical activity
resources) in the required IRS Qualified Allocation Plan criteria.
•
4.9d. IRS should establish a means to fund or subsidize cost of embedding health
services (if needed) in housing developments to incentivize committing space or
employing unused space for such services in their plans.
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•
4.9e. HUD should broaden implementation of indoor smoke-free policies to
include subsidized multi-unit housing, require multi-unit housing adopting smoke-
free policies to provide access to cessation resources (that is, referrals to cessation
resources), and in collaboration with the CDC Office on Smoking and Health, work
to align these policies with its related policies in public housing so as to ensure that
loss of housing is not an unintended consequence.
Recommendation 4.10: The National Clinical Care Commission recommends federal
investments in research that will yield discoveries that generate population-level benefits
in the prevention and control of type 2 diabetes, with a particular focus on elucidating and
changing the social and environmental conditions associated with greater risk of diabetes
and its complications.
•
4.10a. The U.S. Department of Agriculture (USDA), the U.S. Environmental
Protection Agency (EPA), the U.S. Department of Transportation (DoT), the Federal
Trade Commission (FTC), the Federal Communications Commission (FCC), the
Food and Drug Administration (FDA), etc. should fund research into how their
policies and practices affect diabetes risk and management and could be changed
or (if/when beneficial) amplified to better prevent and control diabetes.
•
4.10b. The National Institutes of Health (NIH) and the Centers for Disease Control
and Prevention (CDC) should support large scale natural experiments research --
including cost-effectiveness analysis -- to inform the evidence base related to social
and environmental policies that prevent and control type 2 diabetes. Special focus
should be paid to “health in all policies” types of interventions relevant to non-
health agencies’ activities and other public health (non-clinical) interventions. The
Centers for Medicare & Medicaid Innovation (CMMI) or alternative federal entities
should support demonstration projects in collaboration with non-health agencies
related to influencing social determinants of health and reducing diabetes risk,
improving diabetes control, and preventing complications (for example, USDA’s
SNAP interventions, the U.S. Department of Housing and Urban Development’s
housing interventions, EPA and freshwater interventions, DoT and walkability
interventions).
•
4.10c. Investments in research training need to be made by NIH, CDC, and non-
health agencies to enhance the workforce skilled in the competencies needed to
carry out health impact assessments and related simulation work.
•
4.10d. NIH should expand its initiative on Precision Nutrition to (1) include clinical
trials that can inform critical population health questions related to which foods,
beverages, ingredients, and additives promote/prevent the development of type
2 diabetes; (2) include studies of communication interventions and (counter)
marketing practices to inform which practices work best for which sub-populations
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with respect to changing dietary patterns to prevent type 2 diabetes, and which
practices elevate diabetes risk; (3) expand the definition of “precision” to go
beyond targeting the individual to include targeting cultural and geographic
entities (neighborhoods).
•
4.10e. NIH should encourage that nutrition and metabolic research accurately
quantify water intake and use this information to better study the associations
between water consumption and health across the lifespan. USDA should develop
methods to incorporate water consumption into USDA Food Patterns (water is a
beverage that currently is not a contributor to USDA food groups or subgroups).
•
4.10f. NIH should support research (in collaboration with other federal agencies)
to better understand the role of (1) exposures related to environmental pollutants,
toxins, contaminants, unclean water, and endocrine-disrupting chemicals on
metabolic function and diabetes risk; and (2) life course trauma (including
interpersonal violence, discrimination, racism, and disability) on metabolic function
and diabetes risk, and associated interventions to reduce exposure to such trauma
and/or mitigate the effects of trauma on diabetes outcomes.
Recommendations for Diabetes Prevention in
Targeted Populations (Chapter 5)
Recommendation 5.1: The National Clinical Care Commission recommends increasing
support to CDC for its campaign to raise awareness of prediabetes and promote enrollment
in the National DPP lifestyle change program.
• To more effectively reach populations disproportionately affected by type 2
diabetes risk, CDC should use multiple methods including social media to increase
awareness of prediabetes and the opportunity to delay or prevent type 2 diabetes.
• CDC should continue tracking visits to the Do I Have Prediabetes campaign page
and completions of the prediabetes risk test, with an expanded focus on the
degree to which populations at increased risk are being reached in order to reduce
disparities in awareness and engagement in interventions.
Recommendation 5.2: The National Clinical Care Commission recommends that the
Centers for Medicare & Medicaid Services provide coverage for hemoglobin A1c testing
when used to screen for prediabetes.
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Recommendation 5.3: The National Clinical Care Commission recommends that all
federal agencies that directly deliver or influence the delivery of medical care should
implement the 2019 American Medical Association-proposed prediabetes quality measures
related to screening for abnormal blood glucose, intervention for prediabetes, and retesting
of abnormal blood glucose in patients with prediabetes.*
• These agencies should implement a process for systematically using administrative
and clinical data to identify patients at risk for or already meeting criteria for
prediabetes and to ensure appropriate referral and follow-up.
• To support implementation of these measures, quality-improvement programs
should be introduced to improve performance and reduce disparities.
Recommendation 5.4: The National Clinical Care Commission recommends that funding
be provided to NIH to collect, analyze, and summarize the available data from the Diabetes
Prevention Program study describing the effectiveness and safety of metformin for type 2
diabetes delay or prevention in patients with prediabetes, including subpopulations most
likely to benefit. Such a summary (with safety and efficacy data) should then be used to
inform an appropriate submitter’s request for FDA to review and consider an indication for
the use of metformin in high-risk patients with prediabetes.
Recommendation 5.5: The National Clinical Care Commission recommends, consistent
with provisions of the Patient Protection and Affordable Care Act, that all insurers be
required to provide coverage for participation in and completion of a CDC-recognized
diabetes prevention program for those who are eligible.
Recommendation 5.6: The National Clinical Care Commission recommends that
Congress promote coverage for all proven-effective modes of delivery (for example, in-
person, online, and distance learning [telehealth]) for evidence-based interventions that
produce successful participant outcomes that meet or exceed those of the National DPP
quality standards.
Recommendation 5.7: The National Clinical Care Commission recommends that the
Medicare Diabetes Prevention Program (MDPP) be approved as a permanent covered
benefit (not only a model expansion service) and that coverage of MDPP be expanded to
include virtual delivery. Furthermore, the “once in a lifetime” limit on participation in the
MDPP should be removed.
* The USPSTF now recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 years
who have overweight or obesity. (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/
screening-for-prediabetes-and-type-2-diabetes)
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Recommendation 5.8: The National Clinical Care Commission recommends that CDC
continues its efforts to streamline the CDC recognition process for the National DPP
recognition process while maintaining quality, and that CMS streamline its payment process
for the MDPP. Differences in program eligibility, delivery modality, and duration between the
National DPP (led by CDC) and the MDPP (led by CMS) should also be eliminated or, at a
minimum, reduced.*
Recommendation 5.9: The National Clinical Care Commission recommends that funding
be provided to support the testing of new payment models that allow for greater up-front
payments and more equitable risk-sharing between CMS and MDPP program delivery
organizations. In addition, there should be an increase in payment levels to MDPP program
delivery organizations to make MDPP programs financially sustainable.*
Recommendation 5.10: The National Clinical Care Commission recommends that
financial incentives be provided for state Medicaid programs to cover the National
DPP lifestyle change program and other evidence-based type 2 diabetes prevention
interventions that produce successful participant outcomes that meet or exceed those
of the National DPP quality standards. This should include coverage of all proven modes
of delivery (that is, in-person, online, and distance learning or telehealth) that produce
successful participant outcomes.
Recommendation 5.11: The National Clinical Care Commission recommends
• Funding for the Special Diabetes Program for Indians (SDPI) in five-year increments
so that evidenced-based tribal diabetes prevention programs have the resources
to (1) sustain the effort to combat diabetes and its complications; (2) develop
additional culturally appropriate, high-impact type 2 diabetes prevention
interventions; and (3) evaluate outcomes.
• An increase in SDPI funding to address inflation costs, which have consumed more
than 34% of the program’s resources since 2004, the last year Congress increased
funding for the Special Diabetes Program. In the future, annual increases in funding
should, at a minimum, address the costs of inflation.
• An increase in funding to HRSA’s Delta States Network Grant Program to allow the
program to include type 2 diabetes prevention as a focus.
* The National Clinical Care Commission notes that the CMS CY 2022 Physician Fee Schedule Proposed Rule,
which if adopted, may better align the duration of the MDPP and National DPP, and would increase MDPP
payment for participants who attend at least 9 sessions, was recently posted for public comment.
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Recommendation 5.12: The National Clinical Care Commission recommends funding
type 2 diabetes prevention research to discover how to ensure that all individuals at
high risk of developing type 2 diabetes are able to lower their risk for diabetes and its
complications. Examples of areas for further research include:
• What impediments prevent participation in effective diabetes prevention programs
for communities with the greatest needs?
• Are programs that combine both lifestyle intervention and metformin to prevent
diabetes more effective than programs with either lifestyle change or metformin
alone?
• What is the best number, frequency, duration, and content of lifestyle intervention
sessions to successfully prevent diabetes in the long term?
• What are the barriers to long-term maintenance of weight loss for those people
who successfully completed a diabetes prevention program?
• Finally, dissemination and implementation research is needed to determine how
to best promote the use of effective in-person and virtual diabetes prevention
programs. Such efforts should aim to understand and address barriers at multiple
levels, including systemic policies, health care provider referrals, and patient
uptake.
Recommendation 5.13: The National Clinical Care Commission recommends
• Funding the Special Diabetes Program (SDP) in five-year increments so that new,
innovative research can effectively be developed.
• An increase in SDP program funding to address inflation costs, which have
consumed more than 34% of the program’s resources since 2004, the last year
Congress increased funding for SDP. In the future, annual increases in funding
should, at a minimum, address the costs of inflation.
Recommendations for Diabetes Treatment and Complications
(Chapter 6)
Recommendation 6.1: The National Clinical Care Commission recommends that CMS
update the 2000 Medicare Quality Standards that govern diabetes self-management
training (DSMT) and establish a process for ongoing review, updating, and revision, with
broad input from persons and parties affected by these standards. CMS should ensure
that eligibility, documentation, and reimbursement requirements are clearly defined and
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that they are consistently applied across all parties involved in accreditation, billing, and
reimbursement, including Medicare Administrative Contractors and auditors. Updates
should include a reduction in administrative burden regarding standards, documentation,
and reimbursement requirements for DSMT programs.
Recommendation 6.2: The National Clinical Care Commission recommends that CMS
develop reimbursement mechanisms for community-based diabetes education programs,
as a complement to existing accredited/recognized DSMT programs, when evidence shows
that these programs improve diabetes outcomes.
Recommendation 6.3: The National Clinical Care Commission recommends that CMS
use existing processes to update and regularly reevaluate (at least every three years)
eligibility requirements for various diabetes devices leading to appropriate coverage
determinations when there is sufficient evidence to support such national determinations.
CMS should ensure that, to the extent there are national requirements established,
eligibility, documentation, and reimbursement requirements are clearly defined, and that
they are consistently applied across all parties involved, including Medicare Administrative
Contractors and auditors. In evaluating the data to revise eligibility requirements, CMS
should evaluate the current evidence, including published, peer-reviewed evidence, and
consider both glycemic benefits and non-glycemic benefits (including patient-reported
outcomes, which may include quality-of-life and diabetes distress).
Recommendation 6.4: The National Clinical Care Commission recommends that steps
be taken to ensure an adequate workforce and to enhance and sustain team-based care to
improve outcomes for people with diabetes.
• Establish a process within HHS to routinely assess and identify all health care
workforce needs and ensure that training program funding across agencies is
directed to meet those needs.
• Ensure the Health Resources and Services Administration (HRSA) training programs
are designed to meet unmet needs in the team-based health care workforce.
• Evaluate and address regulatory or statutory limitations on HRSA training programs
that affect the agency’s ability to meet the needs of team-based care and new care
models.
• Increase funding for exemplary HRSA programs that support training health care
professionals in team-based care in medical shortage areas, such as the HRSA
National Health Services Corp.
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• Identify and implement mechanisms for involvement of community health workers,
clinical pharmacists, and integrated (or collaborative) behavioral health services in
existing and future value-based models of care (alternative payment models)
• Enhance funding to AHRQ through Primary Care Extension Programs and other
mechanisms to provide technical assistance to medical practices to implement
team-based care.
Recommendation 6.5: The National Clinical Care Commission recommends that steps be
taken to enhance implementation and sustainability of community health workers (CHWs) as
critical members of the diabetes care teams.
• CMS should clarify and build on the 2013 final rule, expanding the scope of
Medicaid-reimbursable services by CHWs to include social, behavioral, and
economic supports as part of covered services.
◊ Clarify that Medicaid funding is available for CHWs to address social
determinants of health (SDOH), building on the January 7, 2021 - CMS
SDOH Roadmap.
◊ Clarify that CHW qualifications should focus on life experience,
interpersonal skills as natural helpers, community membership, as well as
formal education or clinical training.
◊ Develop policies that require CHW services be delivered in accordance with
evidence-informed standards for CHW programs such as those developed
by the National Committee for Quality Assurance, the CDC CHW Core
Consensus (C3) Project, the Community Guide, and the National Association
of Community Health Workers (NACHW).
• Increase funding to CDC to expand programs to assist all states in infrastructure
development and processes to integrate CHW services in a comprehensive, whole-
person approach that includes economic, behavioral, and social supports, as well
as clinical and preventive services.
Recommendation 6.6: The National Clinical Care Commission recommends that
Congress support use of virtual care modalities in the following ways:
• Remove geographic and originating site restrictions so that CMS can provide
access to telehealth services as appropriate.
• Make permanent the ability for Federally Qualified Health Centers and Rural Health
Centers to provide services by telehealth.
• Make permanent the telehealth waiver for Diabetes Self-management Education
and Support (DSMES)/Diabetes Self-management Training (DSMT); and
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• Maintain coverage for audio-only visits to comply with the Executive Order on
Advancing Racial Equity and Support for Underserved Communities.
Recommendation 6.7: The National Clinical Care Commission recommends that the
Centers for Medicare & Medicaid Innovation (CMMI) fund a demonstration project with the
Health Resources and Services Administration (HRSA) and the Indian Health Service (IHS)
that utilizes a technology-enabled collaborative learning and capacity building model (for
example, Project ECHO-type model) to support uptake and implementation of diabetes
care best practices among primary care providers and care teams. The project should
include training of community health workers, payment for both hub and spoke participants’
time, collection and analysis of interim data, and utilization of a shared-services approach
for training on the telementoring model, infrastructure, and data collection to inform
broader implementation.
• In collaboration with HRSA, provide diabetes-related telementoring to small or
rural health clinics (spokes) to include focus on social determinants of health and
behavioral health issues that impact diabetes outcomes and leverage existing
academic center hubs to support uptake and implementation of diabetes care best
practices.
• In collaboration with IHS and tribal and urban Indian clinics, create supportive
learning and mentorship relationships to assist in implementing diabetes care
best practice and leverage the existing Tribal Epidemiology Centers and academic
center hubs.
Recommendation 6.8: The National Clinical Care Commission recommends that CMS
develop and implement a quality measure to assess potential overtreatment, inappropriate
treatment, or risk of harm among Medicare beneficiaries with diabetes and life-limiting
conditions to reduce the incidence of severe hypoglycemia and improve patient safety.
Recommendation 6.9: The National Clinical Care Commission recommends that federal
policies and programs remove cost barriers to ensure that insulin is affordable for all people
with diabetes and that no one with diabetes who needs insulin cannot get it because of
cost.
Recommendation 6.10: The National Clinical Care Commission recommends that HHS
establish a process to determine and regularly reevaluate high-value diabetes services and
treatments to be fully covered (pre-deductible) by health insurance based on their ability to
prevent development or progression of diabetes complications.
Recommendation 6.11: The National Clinical Care Commission recommends that the
National Institutes of Health prioritize funding for research to identify and address factors
that affect referrals to and patient uptake of DSMES such as patient-, clinician-, and systemic-
level barriers, quality measures and incentives, and patient-reported outcomes and
perspectives.
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Examples of research approaches to be tested include:
• Address social determinants of health and racial and systemic inequities that
prevent populations disproportionately burdened with diabetes from engagement
in DSMES
• Use novel care delivery paradigms that may involve integration and collaboration
of community and clinic systems to broaden referral and uptake of DSMES
• Enhance health care system processes to ensure provider understanding of the
need for DSMES and provide support for making and increasing referrals
• Improve provider communication with people with diabetes and foster shared
decision making to encourage uptake and engagement in DSMES
• Leverage and engage key family members and peer support to enhance
engagement of people with diabetes in the DSMES process
Recommendation 6.12: The National Clinical Care Commission recommends increased
funding for implementation research across federal agencies (for example, AHRQ, NIH,
CMS, HRSA, IHS, CDC, VA, and DoD) to better translate team-based care into practice and
test new team-based care models and payment systems to improve diabetes care and
outcomes.
Recommendation 6.13: The National Clinical Care Commission recommends that digital
connectivity be investigated as a social determinant of health affecting the development
and progression of diabetes.
• The Federal Communications Commission (FCC), the U.S. Department of
Agriculture (USDA), and the U.S. Department of Health and Human Services (HHS)
should expand the scope of an inter-agency memorandum of understanding
(MOU) beyond the Rural Telehealth Initiative or establish another mechanism
to bring together the appropriate federal agencies to share information on and
investigate (1) the relationship between digital connectivity and health; and (2)
the types of digital services and the level of adoption of digital services needed to
make a positive impact on health.
• FCC should conduct research to better understand the associations of digital
connectivity, diabetes prevalence, and improved diabetes health outcomes.
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Alignment Between National Clinical Care Commission’s
Recommendations and Charter/Duties *
Charter/Duties
Recommendations
Foundational Recommendations (Chapter 3)
1, 2, 3, 4, and 5
Recommendation 3.1: The National Clinical Care Commission
recommends the creation of the Office of National Diabetes Policy
(ONDP) to develop and implement a national diabetes strategy
that leverages and coordinates work across federal agencies and
departments to positively change the social and environmental
conditions that are promoting the type 2 diabetes epidemic. The
National Clinical Care Commission further recommends that the
ONDP be established at a level above the U.S. Department of
Health and Human Services (HHS) and be provided with funding
to facilitate its effectiveness and accountability.
1, 2, 3, and 4
Recommendation 3.2: The National Clinical Care Commission
recommends that federal policies and programs be designed to
ensure that all people at risk for and with diabetes have access to
comprehensive, high-quality, and affordable health care and that
no one at risk for or with diabetes who needs health care cannot
get it because of cost.
* National Clinical Care Commission Charge/Duties
1. Federal programs of the Department of Health and Human Services that focus on preventing and reducing
the incidence of complex metabolic or autoimmune diseases that result from insulin-related issues and
represent a significant disease burden in the United States, including complications due to such diseases
2. Current activities and gaps in federal efforts to support clinicians in providing integrated, high-quality care
to individuals with these diseases and complications
3. The improvement in, and improved coordination of, federal education and awareness activities related to
the prevention and treatment of these diseases and complications, which may include the use of existing
and new technologies
4. Methods for outreach and dissemination of education and awareness materials that:
a. Address these diseases and complications
b. Are funded by the federal government
c. Are intended for health care professionals and the public
5. Opportunities for consolidating any inappropriately overlapping or duplicative federal programs related
to these diseases and complications
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Charter/Duties
Recommendations
1, 2, 3, and 4
Recommendation 3.3: The National Clinical Care Commission
recommends that achieving health equity be a component of all
federal policies and programs that affect people at risk for and
with diabetes.
Recommendations for Population-Level Diabetes Prevention and Control
(Chapter 4)
1, 2, and 3
Recommendation 4.1: The National Clinical Care Commission
recommends that the USDA SNAP program be enhanced to
both reduce food insecurity and improve nutrition sufficiency,
both of which will help prevent type 2 diabetes and diabetes
complications.
1 and 2
Recommendation 4.2: The National Clinical Care Commission
recommends that USDA non-SNAP feeding programs be
better leveraged to prevent diabetes in women, children, and
adolescents by (1) enhancing Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC); (2) further
harnessing the National School Lunch and Breakfast Programs to
improve dietary quality; and (3) expanding the Summer Nutrition
Programs and the Fresh Fruit and Vegetable Program.
1 and 2
Recommendation 4.3: The National Clinical Care Commission
recommends that resources be provided to the USDA to create
an environmentally friendly and sustainable U.S. food system
promoting the production, supply, and accessibility of foods
such as “specialty crops” (fresh fruits, dried fruits, vegetables,
tree nuts) that will attenuate the risk for type 2 diabetes and the
complications of diabetes.
1, 2, 3, and 4
Recommendation 4.4: The National Clinical Care Commission
recommends that all relevant federal agencies promote the
consumption of water and reduce the consumption of sugar-
sweetened beverages in the U.S. population, and that they
employ all the necessary tools to achieve these goals, including
education, communication, accessibility, water infrastructure, and
sugar-sweetened beverage taxation.
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Charter/Duties
Recommendations
1, 2, 3, and 4
Recommendation 4.5: The National Clinical Care Commission
recommends that the U.S. Food and Drug Administration (FDA)
improve its food and beverage labeling regulations that influence
both food and beverage industry practices and consumer
behavior to better prevent and control diabetes.
1, 2, 3, 4, and 5
Recommendation 4.6: The National Clinical Care Commission
recommends that the Federal Trade Commission - in order to
prevent children’s exposure to, and consumption of, calorie-dense
and nutrient-poor foods and beverages that can lead to obesity
and type 2 diabetes -- be provided the authority, mandate, and
requisite resources to (a) create guidelines and rules regarding
the marketing and advertising practices of the food and beverage
industry and associated communication networks and platforms
targeted to children younger than 13 years old, (b) restrict industry
practices based on these rules, (c) fully monitor these practices,
and (d) enforce such rules.
1, 2, 3, 4, and 5
Recommendation 4.7: The National Clinical Care Commission
recommends that federal agencies promote and support
breastfeeding to (a) increase breastfeeding rates, (b) enhance
the intensity and duration of breastfeeding among mothers who
breastfeed, and (c) reduce disparities in breastfeeding rates,
duration, and intensity. Additional funding should be provided
for federal programs that promote and support breastfeeding to
overcome persistent societal and employment-based obstacles to
breastfeeding.
1, 2, and 5
Recommendation 4.8: The National Clinical Care Commission
recommends that all federal agencies whose work influences the
ambient (air, water, land, and chemical) and built environments
modify their policies, practices, regulations, and funding decisions
so as to lead to environmental changes to prevent and control
diabetes.
1 and 2
Recommendation 4.9: The National Clinical Care Commission
recommends that, to reduce type 2 diabetes incidence and
diabetes complications, housing opportunities for low-income
individuals and families be expanded, and that such individuals
and families be housed in health-promoting environments.
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Charter/Duties
Recommendations
1, 2, and 5
Recommendation 4.10: The National Clinical Care Commission
recommends federal investments in research that will yield
discoveries that generate population-level benefits in the
prevention and control of type 2 diabetes, with a particular
focus on elucidating and changing the social and environmental
conditions associated with greater risk of diabetes and its
complications.
Recommendations for Diabetes Prevention in Targeted Populations (Chapter 5)
3 and 4
Recommendation 5.1: The National Clinical Care Commission
recommends increasing support to CDC for its campaign to raise
awareness of prediabetes and promote enrollment in the National
DPP lifestyle change program.
2
Recommendation 5.2: The National Clinical Care Commission
recommends that the Centers for Medicare & Medicaid Services
provide coverage for hemoglobin A1c testing when used to
screen for prediabetes.
2 and 4
Recommendation 5.3: The National Clinical Care Commission
recommends that all federal agencies that directly deliver or
influence the delivery of medical care should implement the 2019
American Medical Association-proposed prediabetes quality
measures related to screening for abnormal blood glucose,
intervention for prediabetes, and retesting of abnormal blood
glucose in patients with prediabetes.
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Charter/Duties
Recommendations
1 and 2
Recommendation 5.4: The National Clinical Care Commission
recommends that funding be provided to NIH to collect,
analyze, and summarize the available data from the Diabetes
Prevention Program study describing the effectiveness and safety
of metformin for diabetes delay or prevention in patients with
prediabetes, including subpopulations most likely to benefit. Such
a summary (with safety and efficacy data) should then be used
to inform an appropriate submitter’s request for FDA to review
and consider an indication for the use of metformin in high-risk
patients with prediabetes.
2
Recommendation 5.5: The National Clinical Care Commission
recommends, consistent with provisions of the Patient Protection
and Affordable Care Act, that all insurers be required to provide
coverage for participation in and completion of a CDC-recognized
diabetes prevention program for those who are eligible.
2
Recommendation 5.6: The National Clinical Care Commission
recommends that Congress promote coverage for all proven-
effective modes of delivery (for example, in-person, online, and
distance learning [telehealth]) for evidence-based interventions
that produce successful participant outcomes that meet or exceed
those of the National DPP quality standards.
2
Recommendation 5.7: The National Clinical Care Commission
recommends that the Medicare Diabetes Prevention Program
(MDPP) be approved as a permanent covered benefit (not only
a model expansion service) and that coverage of MDPP be
expanded to include virtual delivery. Furthermore, the “once in a
lifetime” limit on participation in the MDPP should be removed.
2 and 5
Recommendation 5.8: The National Clinical Care Commission
recommends continued efforts to streamline the CDC recognition
process for the National DPP and CMS payment process for the
MDPP while maintaining quality. Differences in program eligibility
and duration between the National DPP (led by CDC) and the
MDPP (led by CMS) should be eliminated or, at a minimum,
reduced.
Report to Congress
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Charter/Duties
Recommendations
2
Recommendation 5.9: The National Clinical Care Commission
recommends that funding be provided to support the testing of
new payment models that allow for greater up-front payments and
more equitable risk-sharing between CMS and MDPP program
delivery organizations. In addition, there should be an increase in
payment levels to MDPP program delivery organizations to make
MDPP programs financially sustainable.
2
Recommendation 5.10: The National Clinical Care Commission
recommends that financial incentives be provided for state
Medicaid programs to cover the National DPP lifestyle change
program and other evidence-based interventions that produce
successful participant outcomes that meet or exceed those of
the National DPP quality standards. This includes coverage of all
proven modes of delivery (that is, in-person, online, and distance
learning or telehealth) for evidence-based interventions that
produce successful participant outcomes.
1 and 4
Recommendation 5.11: The National Clinical Care Commission
recommends
• Funding for the Special Diabetes Program for Indians (SDPI) in
five-year increments so that evidenced-based tribal diabetes
prevention programs have the resources to (1) sustain the
effort to combat diabetes and its complications; (2) develop
additional culturally appropriate, high-impact diabetes
prevention interventions; and (3) evaluate outcomes.
• An increase in SDPI funding to address inflation costs, which
have consumed more than 34% of the program’s resources
since 2004, the last year Congress increased funding for the
Special Diabetes Program. In the future, annual increases in
funding should, at a minimum, address the costs of inflation.
• An increase in funding to HRSA’s Delta States Network Grant
Program to allow the program to include diabetes prevention
as a focus.
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Charter/Duties
Recommendations
3 and 4
Recommendation 5.12: The National Clinical Care Commission
recommends funding type 2 diabetes prevention research
to ensure that all individuals at high risk of developing type
2 diabetes are able to lower their risk for diabetes and its
complications.
3 and 4
Recommendation 5.13: The National Clinical Care Commission
recommends
• Funding the Special Diabetes Program (SDP) in five-year
increments so that new, innovative research can effectively be
developed.
• An increase in SDP program funding to address inflation
costs, which have consumed more than 34% of the program’s
resources since 2004, the last year Congress increased
funding for SDP. In the future, annual increases in funding
should, at a minimum, address the costs of inflation.
Recommendations for Diabetes Treatment and Complications (Chapter 6)
1, 3, and 4
Recommendation 6.1: The National Clinical Care Commission
recommends that CMS update the 2000 Medicare Quality
Standards that govern diabetes self-management training
(DSMT) and establish a process for ongoing review, updating,
and revision, with broad input from persons and parties
affected by these standards. CMS should ensure that eligibility,
documentation, and reimbursement requirements are clearly
defined and that they are consistently applied across all parties
involved in accreditation, billing, and reimbursement, including
Medicare Administrative Contractors and auditors. Updates
should include a reduction in administrative burden regarding
standards, documentation, and reimbursement requirements for
DSMT programs.
Report to Congress
135
Charter/Duties
Recommendations
1, 3, and 4
Recommendation 6.2: The National Clinical Care Commission
recommends that CMS develop reimbursement mechanisms
for community-based diabetes education programs, as a
complement to existing accredited/recognized DSMT programs,
when evidence shows that these programs improve diabetes
outcomes.
1 and 2
Recommendation 6.3: The National Clinical Care Commission
recommends that CMS use existing processes to update
and regularly reevaluate (at least every three years) eligibility
requirements for various diabetes devices leading to appropriate
coverage determinations when there is sufficient evidence to
support such national determinations. CMS should ensure that, to
the extent there are national requirements established, eligibility,
documentation, and reimbursement requirements are clearly
defined, and that they are consistently applied across all parties
involved, including Medicare Administrative Contractors and
auditors. In evaluating the data to revise eligibility requirements,
CMS should evaluate the current evidence, including published,
peer-reviewed evidence, and consider both glycemic benefits
and non-glycemic benefits (including patient-reported outcomes,
which may include quality-of-life and diabetes distress).
1 and 2
Recommendation 6.4: The National Clinical Care Commission
recommends that steps be taken to ensure an adequate workforce
and to enhance and sustain team-based care to improve
outcomes for people with diabetes.
2, 3, and 4
Recommendation 6.5: The National Clinical Care Commission
recommends that steps be taken to enhance implementation
and sustainability of community health workers (CHWs) as critical
members of the diabetes care teams.
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Charter/Duties
Recommendations
2, 3, and 4
Recommendation 6.6: The National Clinical Care Commission
recommends that Congress support use of virtual care modalities
in the following ways:
• Remove geographic and originating site restrictions so that
CMS can provide access to telehealth services as appropriate.
• Make permanent the ability for Federally Qualified Health
Centers and Rural Health Centers to provide services by
telehealth.
• Make permanent the telehealth waiver for Diabetes Self-
management Education and Support (DSMES)/Diabetes Self-
management Training (DSMT); and
• Maintain coverage for audio-only visits to comply with the
Executive Order on Advancing Racial Equity and Support for
Underserved Communities.
1, 2, and 3
Recommendation 6.7: The National Clinical Care Commission
recommends that the Centers for Medicare & Medicaid Innovation
(CMMI) fund a demonstration project with the Health Resources
and Services Administration (HRSA) and the Indian Health Service
(IHS) that utilizes a technology-enabled collaborative learning
and capacity building model (for example, Project ECHO-type
model) to support uptake and implementation of diabetes care
best practices among primary care providers and care teams.
The project should include training of community health workers,
payment for both hub and spoke participants’ time, collection
and analysis of interim data, and utilization of a shared-services
approach for training on the telementoring model, infrastructure,
and data collection to inform broader implementation.
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137
Charter/Duties
Recommendations
1, 2, and 5
Recommendation 6.8: The National Clinical Care Commission
recommends that CMS develop and implement a quality measure
to assess potential overtreatment, inappropriate treatment,
or risk of harm among Medicare beneficiaries with diabetes
and life-limiting conditions to reduce the incidence of severe
hypoglycemia and improve patient safety.
1, 2, and 5
Recommendation 6.9: The National Clinical Care Commission
recommends that federal policies and programs remove cost
barriers to ensure that insulin is affordable for all people with
diabetes and that no one with diabetes who needs insulin cannot
get it because of cost.
1 and 2
Recommendation 6.10: The National Clinical Care Commission
recommends that HHS establish a process to determine and
regularly reevaluate high-value diabetes services and treatments
to be fully covered (pre-deductible) by health insurance based on
their ability to prevent development or progression of diabetes
complications.
1, 3, and 4
Recommendation 6.11: The National Clinical Care Commission
recommends that the National Institutes of Health prioritize
funding for research to identify and address factors that affect
referrals to and patient uptake of DSMES such as patient-,
clinician-, and systemic-level barriers, quality measures and
incentives, and patient-reported outcomes and perspectives.
1, 2, 3, and 4
Recommendation 6.12: The National Clinical Care Commission
recommends increased funding for implementation research
across federal agencies (for example, AHRQ, NIH, CMS, HRSA,
his, CDC, VA, and DoD) to better translate team-based care into
practice and test new team-based care models and payment
systems to improve diabetes care and outcomes.
1, 2, 3, 4, and 5
Recommendation 6.13: The National Clinical Care Commission
recommends that digital connectivity be investigated as a social
determinant of health affecting the development and progression
of diabetes.
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Appendix D. National Clinical Care Commission Act
PUBLIC LAW 115-80—NOV. 2, 2017 • 131 STAT. 1261
Nov. 2, 2017
Public Law 115-80
[S. 920]
115th Congress
National Clinical Care Commission Act.
Evaluation. Recommendations.
An Act
To establish a National Clinical Care Commission.
Be it enacted by the Senate and House of Representatives ofthe United States of
America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Natonal Clinical Care Commission Act’’.
SEC. 2. NATIONAL CLINICAL CARE COMMISSION.
(a)
ESTABLISHMENT.—There is hereby established, within the Department of Health and
Human Services, a National Clinical Care Commission (in this section referred to as
the ‘‘Commission’’) to evaluate and make recommendations regarding improve-
ments to the coordination and leveraging of programs within the Department and
other Federal agencies related to awareness and clinical care for at least one, but not
more than two, complex metabolic or autoimmune diseases resulting from issues
related to insulin that represent a significant disease burden in the United States,
which may include complications due to such diseases.
(b)
MEMBERSHIP.—
(1) IN GENERAL.—The Commission shall be composed of the
following voting members:
(A) The heads of the following Federal agencies and
departments, or their designees:
(i)
The Centers for Medicare & Medicaid Services.
(ii)
The Agency for Healthcare Research and Quality.
(iii)
The Centers for Disease Control and Prevention.
(iv) The Indian Health Service.
(v)
The Department of Veterans Affairs.
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(vi) The National Institutes of Health.
(vii) The Food and Drug Administration.
(viii) The Health Resources and Services Administration.
(ix) The Department of Defense.
(x)
The Department of Agriculture.
(xi) The Office of Minority Health.
(A) Twelve additional voting members appointed under
paragraph (2).
(1) ADDITIONAL MEMBERS.—The Commission shall include
additional voting members, as may be appointed by the Secretary,
with expertise in the prevention, care, and epidemiology of any of the
diseases and complications described in subsection
131 STAT. 1262 PUBLIC LAW 115-80—NOV. 2, 2017
(a)
, including one or more such members from each of the following categories:
(A) Physician specialties, including clinical endocrinologists,
that play a role in the prevention or treatment of diseases and
complications described in subsection (a).
(B) Primary care physicians.
(C) Non-physician health care professionals.
(D) Patient advocates.
(E) National experts, including public health experts,in the duties
listed under subsection (c).
(F) Health care providers furnishing services to a patient population
that consists of a high percentage (asspecified by the Secretary) of
individuals who are enrolled in a State plan under title XIX of the
Social Security Act or who are not covered under a health plan or
health insurance coverage.
(3) CHAIRPERSON.—The members of the Commission shall select a
chairperson from the members appointed under para- graph (2).
(4)MEETINGS.—The Commission shall meet at least twice, and not
more than four times, a year.
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(5)VACANCIES.—A vacancy on the Commission shall be filled in the
same manner as the original appointments.
(c)
DUTIES.—The Commission shall evaluate and make recommendations, as appro-
priate, to the Secretary of Health and Human Services and Congress regarding—
(1) Federal programs of the Department of Health and Human
Services that focus on preventing and reducing the incidence of the
diseases and complications described in sub- section (a);
(2) current activities and gaps in Federal efforts to support clinicians
in providing integrated, high-quality care to individuals with the
diseases and complications described in subsection(a);
(3) the improvement in, and improved coordination of, Federal
education and awareness activities related to the prevention
and treatment of the diseases and complications describedin
subsection (a), which may include the utilization of newand existing
technologies;
(4) methods for outreach and dissemination of education and
awareness materials that—
(A) address the diseases and complications describedin
subsection (a);
(B) are funded by the Federal Government; and
(C) are intended for health care professionals and thepublic; and
(1) whether there are opportunities for consolidation of
inappropriately overlapping or duplicative Federal programs related to
the diseases and complications described in sub- section (a).
(d)
OPERATING PLAN.—Not later than 90 days after its first meeting, the Commission shall
submit to the Secretary of Healthand Human Services and the Congress an oper-
ating plan for carrying out the activities of the Commission as described in subsec-
tion(c). Such operating plan may include—
PUBLIC LAW 115-80—NOV. 2, 2017
131 STAT. 1263
(1) a list of specific activities that the Commission plansto
conduct for purposes of carrying out the duties describedin each of
the paragraphs in subsection (c);
(2) a plan for completing the activities;
Report to Congress
141
(3)
list of members of the Commission and other individuals who
are not members of the Commission who will needto be involved to
conduct such activities;
(4) an explanation of Federal agency involvement and coordination
needed to conduct such activities;
(5) a budget for conducting such activities; and
(6) other information that the Commission deems appropriate.
(e) FINAL REPORT.—By not later than 3 years after the dateof the Commission’s first
meeting, the Commission shall submitto the Secretary of Health and Human
Services and the Congressa final report containing all of the findings and recom-
mendations required by this section.
(f) SUNSET.—The Commission shall terminate 60 days after submitting its final report, but
not later than the end of fiscal year 2021.
Approved November 2, 2017.
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Appendix E. National Clinical Care Commission
Charter
THE SECRETARY OF HEALTH AND HUMAN SERVICES
WASHINGTON, D.C. 20201
CHARTER
NATIONAL CLINICAL CARE COMMISSION
COMMITTEE’S OFFICIAL DESIGNATION
National Clinical Care Commission
AUTHORITY
The National Clinical Care Commission (hereafter referred to as the Commission) is required
under the National Clinical Care Commission Act (Public Law 115-80). The Commission is
governed by provisions of the Federal Advisory Committee Act (FACA), Public Law 92-463,
asamended (5 U.S.C. App.), which sets forth standards for the formation and use of federal
advisory committees.
OBJECTIVES AND SCOPE OF ACTIVITIES
The Secretary of Health and Human Services (Secretary) is required to establish a
committee to evaluate and make recommendations regarding improvements to the
coordination and leveraging of programs within the Department and other Federal
agencies related to awareness and clinical care for at least one, but not more than two,
complex metabolic or autoimnmne diseases resultingfrom issues related to insulin
that represent a significant disease burden in the United States, which may include
complications due to such diseases.
DESCRIPTION OF DUTIES
The Commission shall evaluate and make recommendations, as appropriate, to the
Secretary andCongress regarding:
1. Federal programs of the Department of Heal th and Human Sef\i ices that focus on
preventing and reducing the incidence of complex metabolic or autoimmune
diseasesresulting from issues related to insulin that represent a signiffount
Report to Congress
143
disease burden in the United States, which may include complications due to
such diseases;
2. Current activities and gaps in Federal efforts to support clinicians in providing
integrated, high-quality care to individuals with the diseases and complications;
3. The improvement in, and improved coordination of, Federal education and
awareness activities related to the prevention and treatment of the diseases and
complications, which may include the utilization of new and existing technologies;
4. Methods for outreach and dissemination of education and awareness materials that
a. address the diseases and complications;
b. are funded by the Federal Government; and
c. are intended for health care professionals and the public; and
5. Whether there are opportunities for consolidation of inappropriately overlapping or
duplicative Federal programs related to the diseases and complications.
AGENCY OR OFFICIAL TO WHOM THE COMMISSION
REPORTS
The Commission shall provide recommendations to the Secretary and Congress.
Not later than 90 days after its first meeting, the Commission shall submit to the
Secretary and the Congress an operating plan for carrying out the activities of the
Commission. Such operatingplan may include:
1. A list of specific activities that the Commission plans to conduct for purposes of
carrying out the duties described above;
2. A plan for completing the activities;
3. A list of members of the Commission and other individuals who are not members
of the Commission who will need to be involved to conduct such activities;
4. An explanation of Federal agency involvement and coordination needed to
conduct such activities;
5. A budget for conducting such activities; and
6. Other information that the Commission deems appropriate.
By not later than three years after the date of the Commission’s first meeting, the
Commissionshall submit to the Secretary and the Congress a final report containing all of
the findings and recommendations required.
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SUPPORT
The Assistant Secretary for Health (ASH) shall provide guidance and oversight for
the Commission’s function and activities. Management and support services for the
Commission’s activities shall be provided by the Office of Disease Prevention and
Health Promotion (ODPHP). ODPHP is a program office within the Office of the Assistant
Secretary for Health (OASH), which is a staff division within the Office of the Secretary in
the Department of Health and Human Services.
ESTIMATED ANNUAL OPERATING COSTS AND STAFF YEARS
The estimated annual cost for operating the Commission, including travel expenses for
membersbut excluding staff support is $435,036. The estimated annual staff support
required for the Commission is 1.30 at an estimated annual cost of $289,400.
DESIGNATED FEDERAL OFFICER (DFO)
The ASH shall select the Designated Federal Officer (DFO) from among permanent
full-time or part-time staff within OASH, who has knowledge of the subject matter and
skills and experiencenecessary to manage the Commission. The ASH may appoint an
Alternate DFO who shall carry out these duties in the event that the appointed DFO
cannot fulfill the assigned responsibilities for the Commission. In the absence of the
appointed DFO or Alternate DFO, the ASH shall temporarily appoint one or more
permanent full-time or part-time program staff to carry out the assigned duties.
The DFO shall schedule and approve all meetings of the Commission and any
subcommittees that may be established by the Commission. The DFO shall prepare and
approve all meeting agendas. The DFO may collaborate with the Commission Chair in
this activity, and when deemed appropriate, with chairs of any existing subcommittees
that have been established by the Commission. The DFO, Alternate DFO, or designee
shall attend all meetings of the Commission and all meetings of any subcommittees
that have been established to assist the Commission. TheDFO has authority to adjourn
meetings, when it is determined to be in the public interest, and the DFO can be
directed by the Secretary or designee to chair meetings of the Commission.
ESTIMATED NUMBER AND FREQUENCY OF MEETINGS
The Commission shall meet at least twice and not more than four times a year. These
meetings will be in person, but may be conducted by teleconference or videoconference
at the discretion ofthe DFO. The meetings shall be open to the public, except as
determined otherwise by the Secretary, or other official to whom authority has been
delegated, in accordance with the guidelines under Government in the Sunshine Act,
5 U.S.C. 552b(c). Notice of all meetings shallbe provided to the public in accordance
Report to Congress
145
with the FACA. Meetings shall be conducted and records of the proceedings shall be
kept, as required by applicable laws and departmental policies. A quorum is required for
the Commission to meet to conduct business. A quorum shall consist of a majority of the
Commission’s voting members.
When the Secretary or designee determines that a meeting shall be closed or partially
closed to the public, in accordance with stipulations of Government in the Sunshine Act, 5
U.S.C. 552b(c),then a report shall be prepared by the DFO that includes, at a minimum, a
list of members and their business addresses, the Commission’s functions, date and place
of the meeting, and a summary of the Commission’s activities and recommendations made
during the fiscal year. A copy of the report will be provided to the Department Committee
Management Officer.
DURATION
Establishment of the Commission was mandated under the National Clinical Care
Commission Act (Public Law 115-80). The Commission shall operate pursuant to the
stipulations in the authorizing legislation.
TERMINATION
Unless extended by Congress, the Commission shall terminate 60 days after submitting its
final report, but not later than the end of fiscal year 2021. Unless renewed by appropriate
action, the charter for the Commission will expire two years from the date it is filed.
MEMBERSHIP AND DESIGNATION
The Commission shall consist of 23 voting members. The composition shall include eleven
exofficio members and twelve non-federal members. The ex-officio members shall consist
of the heads of, or subordinate officials designated by the heads of, the following federal
departments, agencies, or components: The Centers for Medicare and Medicaid Services,
the Agency for Healthcare Research and Quality, the Centers for Disease Control and
Prevention, the Indian Health Service, the Department of Veterans Affairs, the National
Institutes of Health, the Food and Drug Administration, the Health Resources and Services
Administration, the Department ofDefense, the Department of Agriculture, and the Office of
Minority Health.
The twelve non-federal members shall be appointed as special government employees
(SGEs) bythe Secretary and shall have expertise in prevention, care, and epidemiology
of any of the diseases and complications described in Section 2(a) of the National
Clinical Care Commission Act. The non-federal members shall include at least one
individual from each of the following categories: physician specialties, including
clinical endocrinologists, that play a role in the prevention or treatment of diseases
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and complications; primary care physicians; non-physician health care professionals;
patient advocates; national experts, including public health experts; and health care
providers furnishing services to a patient population that consists of a high percentage
(as specified by the Secretary) of individuals who are enrolled in a State plan under
title XIX of the Social Security Act or who are not covered under a health plan or
health insurance coverage. One of the non-federal members shall be selected by the
members of the Commission to serve as the Chair.
The ex-officio members and non-federal members shall be appointed to serve for the
duration of the time that the Commission is authorized to operate. Any vacancy of a
non-federal member shall be filled in the same manner as the original appointments.
Any non-federal member who is appointed to fill the vacancy of an unexpired term shall
be appointed to serve for the remainder of that term.
Pursuant to advance written agreement, each non-federal member of the Commission
will waive his or her right to compensation for performing services as a member of the
Commission.
However, non-federal members shall receive per diem and reimbursement for
travel expenses incurred in relation to performing duties for the Commission, as
authorized by FACA and 5 U.S.C. §5703 for persons who are employed intermittently
to perform services for the Federal government and in accordance with Federal travel
regulations. Ex-officio members of the Commission remain covered under their current
compensation system.
SUBCOMMITTEES
In carrying out its function, the Commission (with the approval of the DFO) may
establish subcommittees composed of members of the Commission, as well as
other individuals who have expertise and knowledge about the topics and issues
that are pertinent to the mission of the Commission. The established subcommittees
may consider issues in accordance with the mission of the Commission, and shall,
as appropriate, make recommendations and/or reports to the Commission for
consideration. Recommendations and/or reports of the subcommittee that are
provided to the Commission shall be discussed at an open public meeting that is held
by the Commission. No established subcommittee of the Commission may report
directly to the Secretary or another federal official unless there is specific statutory authority
for such reporting. The Department Committee Management Officer shall be notified
upon establishment of each subcommittee, and shall be given information regarding its
name, membership, function, cost, and estimated frequency of meetings.
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RECORDKEEPING
Records of the Commission and any established subcommittees shall be handled in
accordance with the General Records Schedule 6.2, Federal Advisory Committee Records
or other approvedagency records disposition schedule. Applicable records shall be
made available to the public forinspection and copying, subject to the Freedom of
information Act, 5 U.S.C. 552.
FILING DATE:
April 3, 2020
APPROVED:
APR 01 2020
Date
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Appendix F. Acronyms and Abbreviations
Acronyms &
Definitions
Abbreviations
ACA
Affordable Care Act
AHRQ
Agency for Healthcare Research and Quality
C3 Project
CHW Core Consensus Project
CDC
Centers for Disease Control and Prevention
CGM
Continuous glucose monitor
CHIP
Children’s Health Insurance Program
CHW
Community health worker
CMMI
Center for Medicare and Medicaid Innovation
CMS
Centers for Medicare & Medicaid Services
CPI-U
Consumer Price Index U.S. city average
DFO
Designated Federal Officer
DKA
Diabetic ketoacidosis
DMICC
Diabetes Mellitus Interagency Coordinating Committee
DoD
United States Department of Defense
DOL
United States Department of Labor
DOT
United States Department of Transportation
DPP
Diabetes Prevention Program
DSMES
Diabetes Self-Management Education and Support
DSMT
Diabetes Self-Management Training
ECHO
Extension for Community Healthcare Outcomes
EDC
Endocrine disrupting chemical
EPA
United States Environmental Protection Agency
FACA
Federal Advisory Committee Act
FCC
Federal Communications Commission
FDA
United States Food and Drug Administration
FFV
Fresh Fruit and Vegetable
FNS
Food Nutrition Service
FTC
Federal Trade Commission
Report to Congress
149
Acronyms &
Definitions
Abbreviations
GusNIP
Gus Schumacher Nutrition Incentive Program
HbA1c
Hemoglobin A1c
HDL
High-density lipoprotein
HFFI
Healthy Food Financing Initiative
HHFK
Healthy, Hunger-Free Kids Act
HHS
United States Department of Health and Human Services
HIA
Health Impact Assessment
HiAP
Health in All Policies
HOPD
Hospital outpatient department
HRSA
Health Resources and Services Administration
HUD
United States Department of Housing and Urban Development
IHS
Indian Health Service
IMPaCT
Infrastructure for Maintaining Primary Care Transformation
IRS
Internal Revenue Service
LCD
Local coverage determination
MCO
Managed care organization
MDPP
Medicare Diabetes Prevention Program
MNT
Medical Nutrition Therapy
NACHW
National Association of Community Health Workers
NCCC
National Clinical Care Commission
NCD
National coverage determination
NHANES
National Health and Nutrition Examination Survey
NIDDK
National Institute of Diabetes and Digestive and Kidney Diseases
NIH
National Institutes of Health
NSDSMT
National Standards for Diabetes Self-Management Education and
Support
OASH
HHS Office of the Assistant Secretary for Health
ONDP
Office of National Diabetes Policy
OWH
Office on Women’s Health
PCEP
Primary Care Extension Program
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Department of Health and Human Services
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Acronyms &
Definitions
Abbreviations
PFS
Physician Fee Schedule
QAP
Qualified Allocation Plan
SCRI
Specialty Crop Research Initiative
SDOH
Social determinants of health
SDP
Special Diabetes Program
SDPI
Special Diabetes Program for Indians
SNAP
Supplemental Nutrition Assistance Program
SNAP-Ed
Supplemental Nutrition Assistance Program Education
SSB
Sugar-sweetened beverage
TFP
Thrifty Food Plan
U.S.
United States of America
UNICEF
United Nations Children’s Emergency Fund
USDA
United States Department of Agriculture
USPSTF
United States Preventive Services Task Force
VA
United States Department of Veteran Affairs
VBP
Value-based payment
WIC
Special Supplemental Nutrition Program for Women, Infants and
Children
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151
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Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020:
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national-diabetes-statistics-report.pdf
3.
Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the
year 2050 burden of diabetes in the US adult population: dynamic modeling
of incidence, mortality, and prediabetes prevalence. Popul Health Metr. Oct 22
2010;8:29. doi:10.1186/1478-7954-8-29
4.
American Diabetes Association. Economic costs of diabetes in the U.S. in 2017.
Diabetes Care. May 2018;41(5):917-928. doi:10.2337/dci18-0007
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Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and
public health, 1996-2013. JAMA. Dec 27 2016;316(24):2627-2646. doi:10.1001/
jama.2016.16885
6.
Prevalence of Both Diagnosed and Undiagnosed Diabetes. Centers for Disease Control
and Prevention. Updated June 24, 2020. Accessed August 19, 2021. https://www.
cdc.gov/diabetes/data/statistics-report/diagnosed-undiagnosed-diabetes.html
7.
Diabetes: Trends Among Children and Adolescents. Centers for Disease Control and
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report/newly-diagnosed-diabetes.html
8.
1 in 5 adolescents and 1 in 4 young adults now living with prediabetes. Press Release.
Centers for Disease Control and Prevention; 2019. https://www.cdc.gov/media/
releases/2019/p1202-diabetes.html
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Ogden CL, Carroll MD. Prevalence of overweight, obesity, and extreme obesity among
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Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity
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National Commission on Diabetes. Report of the National Commission
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Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al.
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long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. Sep
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Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of
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2002;346(6):393-403. doi:10.1056/NEJMoa012512
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Hill-Briggs F, Adler NE, Berkowitz SA, et al. Social determinants of health and diabetes:
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