June 2018

Bill Will Allow NPs, PAs to Certify Need for Diabetic Shoes

New legislation was recently introduced that would allow nurse practitioners (NPs) and physician assistants (PAs) to satisfy Medicare’s documentation requirement for coverage of certain shoes for people with diabetes, allowing those patients easier access to that care. The bill, “Promoting Access to Diabetic Shoes Act,” was introduced into the 115th Congress by Senators Sherrod Brown (D-OH) and Susan Collins (R-ME).

“Therapeutic shoes are a proven method for preventing costly and painful complications related to diabetes, yet current Medicare regulations force patients to endure a time-consuming process to obtain them,” said Collins.

NPs and PAs often act as sole primary care providers for many patients with diabetes, particularly in underserved and rural communities — yet current law requires that they send their diabetic Medicare patients who need therapeutic shoes to a physician who will then certify that the patient in fact needs these shoes. The physician is then required to become the provider managing the patient’s diabetic condition moving forward. Not only does the current law impose additional costs on the Medicare program by requiring the participation of an additional provider, but it can result in delays for patients, which could jeopardize their health.

A March 2018 article in The American Journal of Medicine found NPs, PAs, and physicians are comparable in the management of diabetes at diagnosis and during the first five years of follow-up care.

The American Association of Nurse Practitioners, the American Academy of Physician Assistants, and the American Podiatric Medical Association endorse the legislation.

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