Industry News: Home Health Plans of Care: Monitoring Glucose Control in Type II Diabetes Mellitus patients
February 16th, 2015

Home Health Membership News - February 6, 2015

Palmetto GBA LCD Reminder

Home Health Plans of Care: Monitoring Glucose Control in Type II Diabetes Mellitus patients

Effective December 30, 2014


This is a reminder that Palmetto’s Diabetes II Local Coverage Determination (LCD) Policy is in effect.  To view the entire policy, along with comments received from CMS last year, go to:


In addition, the 16 State Medicare Coalition discussed this policy last week with Palmetto who provided the following additional questions/answers this morning:


Q1:  Is this LCD applicable to all diabetic care plans or for those patients where the agency is monitoring the insulin? (During the meeting, the question was somewhat modified and records as Is the LCD requirement for all diabetic patients or just Type II diabetics receiving insulin injections on a daily basis?

A1: The Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus (L35413) applies to all patients with Type II Diabetes Mellitus (DM). If the agency is billing a Type II DM code on the claim, and included it in the OASIS, then the provider should follow the policy requirements.


Q2:  If an episode ended, for example, the first week of January and an A1c had not been ordered, could the agency still bill?

A2:  Yes. The LCD applies to episodes that begin on or after December 30, 2014.


Q3:  If a patient was opened in early December, for example, with an episode ending in February – is the A1c required prior to billing that episode?

A3: The effective date of the policy is for services performed on or after 12/30/2014. The policy was not in effect when the patient was opened in early December. Therefore, an A1c is not required prior to billing the episode.


Q4:  For both Start of Care (SOC) and recertification episodes beginning after January 1, 2015, the A1c is required?

A4:  Yes. The LCD applies to both SOC and recertification episodes that begin on or after December 30, 2014.


Q5:  Was there discussion during the comment period on the promotion of Metformin in the LCD?

A5:  As a standard operating procedure, Palmetto GBA uses several resources to develop and support LCDs. One particular resource is peer-reviewed literature. The "sources of information" cited in the LCD discuss the evidence-based algorithm that supports the use of Metformin. The LCD contains an electronic link to the article and algorithm.


Sources of Information and Basis for Decision

       i.         Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes, which can be viewed at


A recent peer-reviewed article also reinforces the risks of over treatment. It was published in the JAMA Internal Medicine on January 12, 2015. The study is titled, Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control. The article can be accessed at


Q6:  If a visit is made for another reason, but the patient is diabetic and part of the care requires monitoring the patient’s glucose levels, would this LCD apply?

A6:  The LCD applies to all patients with Type II DM when the POC includes monitoring of the patient’s glucose level and/or daily insulin injections.


Q7:  If the patient’s physician refuses to order the H1A1c test, what should the HHA do if the POC requires monitoring of the patient’s diabetic condition?

A7:  The physician who establishes the plan of care must sign and date the certification. Among the requirements that the physician is "certifying" is that a plan of care has been established and will be periodically reviewed by a physician. The HHA should ask the physician for the test results as they may already have them in their records.

Posted by Sharron Smitherman in Home Health

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