On 6/11/18 Medicare announced a change in policy to allow Medicare beneficiaries to use smartphones in conjunction with continuous glucose monitors.
“After a thorough review of the law and our regulations, CMS is announcing that Medicare’s published coverage policy for CGMs will be modified to support the use of CGMs in conjunction with a smartphone, including the important data sharing function they provide for patients and their families.
The Durable Medical Equipment Medicare Administrative Contractors will issue a revised policy article in the near future, at which time the published change will be effective.”
I have not blogged about this change for several reasons. 1) I am a lazy blogger. 2) I was quoted extensively in articles by Diabetes Mine and Diabetes Daily about my reactions to the announcement. 3) Most of my diabetes preaching these days takes place on Facebook. Today I decided to enter the arena with a blogpost because of the chaos on diabetes social media about what this announcement means and when it will be implemented.
Dexcom initiated the confusion with a 6/11/18 press release that states: “With nearly half of adults ages 65 and up using smartphones, Medicare diabetes patients are now able to use the Dexcom Share feature that allows users to share glucose information with up to five loved ones or caregivers.”
The problem is the word “now.” Now is not the near future as stated by CMS. Adding to the confusion is that a definitive policy was not communicated and standardized throughout the Dexcom organization and some Medicare beneficiaries were told by Dexcom reps that they could immediately begin using the G5 Mobile App.
A couple of Facebook quotes:
“Damnit. Dexcom said it was good to go last night.”
“I called Dexcom support/app & software department again today they checked & confirmed that we could start using it as of June 11.”
“It would help us all if CMS or Dexcom would give a definitive statement about when. There is no hard statement about waiting.”
On top of that, Diatribe (whom I normally consider to be the Gospel of Diabetes) published an article that is not entirely correct. It states: “Like other users, G5 Medicare beneficiaries can now choose to view real-time glucose data on the G5 app only, the receiver only, or both devices.”
Christel Marchand Aprigliano of DPAC who has met extensively with Dexcom and Tandem in regards to the Medicare negotiations responded on Facebook: “The receiver will still be part of the system. It is still required as part of any Medicare contract. The usage of the app will be in addition to the receiver.”
She also stated:
“While I can’t speak for CMS (Who will obviously have the final say), the meeting on Wednesday was that it would be receiver + smart phone. The receiver is durable medical equipment and the modification of language will reflect the addition of smart device (but not the purchase of said smart device).”
The date of implementation for the policy change is somewhat murky. A Dexcom official confirmed with Medicare diabetes advocate, Larry Thomas, that: “It becomes official on June 21. The technical correction notice must be updated in 10 business days from the notice.” Diatribe also wrote: “According to Dexcom, the deadline for the Centers for Medicare and Medicaid Services (CMS) to update the coverage policy is June 21, if not sooner.”
But Christel cautions us that regardless of date:
“Do NOT download the app until the actual physical ruling has been changed.”
The last quote that I will share is a June 14 Facebook posting by Larry Thomas about his conversation with a Dexcom Medicare representative:
“The old regulations regarding NOT using the G5 app for Medicare patients are still in place and Dexcom representatives are still required and instructed to report you to Medicare if you are using the G5 mobile app until the rules are changed. This means not only will you be back charged if you are not in compliance, but you will possibly lose future coverage for Dexcom CGM supplies in the future i.e. you will become a cash-only patient with Dexcom. These are her words not mine. If you doubt them please call and speak with a representative in the Medicare department at Dexcom. Remember, just because a tech support person or app support person gives you the okay to use the app, it does not waive your responsibility to abide by the written contract you signed in order for you to get coverage by Medicare for the Dexcom CGM system. I have again requested Dexcom to send out an email to all of us affected by this situation to clarify that it’s “not a done deal yet” (again her words not mine) and have also reached out (again) to the media release department at Dexcom to change the media release so that people are not confused by this.”
What you need to know if your Dexcom G5 is being reimbursed by Medicare:
1) You are not yet allowed to use the Dexcom G5 Mobile App. You must wait until the revised policy is issued by DME Medicare Administrative Contractors (MAC’s) such as Noridian. If you use your smartphone before this revision is released, you are in violation of Medicare policy and risk losing Medicare reimbursement for your Dexcom G5.
2) It is highly unlikely that you will be able to your smartphone exclusively without some use of the receiver. “In conjunction” means “with” and “combining” not burying the receiver in a sock drawer. IMO it is best to refrain from sharing your receiver-avoidance intentions on social media until the final CMS policies are released. Don’t give CMS ammunition to contrive stupid roadblocks to reasonable CGM use by Medicare beneficiaries.
3) Do not call Dexcom at this time. Christel Marchand Aprigliano of DPAC told me: “Tell everyone to wait for the policy change from CMS in writing – Dexcom will put out information when it becomes available. Please kindly also remind them that the customer service department at Dexcom is trying very hard to provide good customer service, but it is not in anyone’s best interest to call – wait for the announcement published by Dexcom on the website (and I’m sure we will be announcing this as well.)”
4) Nothing about this recent change in policy affects the use of the Tandem X2 insulin pump as a CGM receiver. Although Tandem and Dexcom are in negotiation with CMS, the current policy is that Medicare beneficiaries are forbidden from using their Tandem t:slim X2 pumps as a Dexcom G5 receiver.
Special thanks to Christel Marchand Aprigliano of DPAC and Larry Thomas, bulldog Medicare diabetes advocate, for giving me permission to share their words.
Note that all bold text in this post is my emphasis and not that of the organization or person being quoted.
So very well explained. We have come such a very long way in getting CGM coverage with CMS and this wait (all things considered) will not be a huge deal in the least.
Patience is key and once the verbiage is made available we need to read and re-read to be sure we understand what will be approved and how to utilize the tools within the CMS rules.
Again … PATIENCE is paramount.
A very good explanation Laddie.
I have just received a letter from Medicare that states, in summary, that, effective June 7, 2018, the Centers for Medicare and Medicaid Services revised their guidance for the use of alternate CGM display units, making them eligible for the CGM supply allowance payment when used in combination with the Dexcom CGM unit. Therefore, when the Dexcom receiver is used sometimes and the t:slim pump is used at other times, coverage of the monthly CGM supply allowance is now allowed.
I am now using my t:slim pump during the day and my Dexcom receiver overnight. I always use my iPhone with both (and my husband is my follower). Just remember that a single transmitter cannot be connected to both the pump and Dexcom receiver at the same time.
Are u saying it’s “now” allowed or “not” allowed? I thought the new ruling allows it.
NOW allows it
Whoops! I need to correct the post I wrote yesterday. Switching back and forth from my Dexcom Receiver and my t:slim X2 pump each night didn’t work. I think I will need to only switch when I put on a new sensor once a week.
Yes, very excellent explanation. Thank you so much.
Excellent points. Thanks for your work on this topic.
Laddie, what an excellent explanation to this situation! Thanks for all you do to make diabetic life a little easier. It is greatly appreciated.
Laddie, thanks so much for your blog about this. I know a lot of folks have been told and are reading articles that say they can start now. As in today. It’s sad that even Dexcom has not notified all their employees of the status of this possible change (I say possible because we really don’t know of the final outcome yet.) I would hope that we can have a lot of latitude with using the receiver, I would certainly prefer using it at home and during the night. When I’m out and about on my wilderness treks, I would much rather the phone and a smart watch. Keep up your good work letting us know the real facts. Not only here, but on Facebook.
Well expressed. I am one of the people who dowloaded the app on day 1 based on the Dexcom press release. This was compounded by a phone call to Dexcom the next day in which I was told no, you don’t have to delete the app. Which I eventually did anyway. I believe Dexcom has responsibility, even legal liability, if Medicare tries to charge me. Hope it doesn’t come to that, but I think they screwed up and would have a hard time defending themselves.
It is a wonderful decision. I love the change in decision.
Thanks again for this great blog!!
Laddie, when I first heard this news, I thought of you!! Thanks for this excellent explanation of the current standings. But does using a smart phone & the share mean they approve of using s smart watch too, not that they could track that. But I imagine they don’t want people using medicare to say, “please pay for my smart watch that is integral to my bg monitoring.” just curious. Or is this a mute point because they can’t track the use. Thanks again for your awesome blog. U go above and beyond making sure those of us of “advanced” age have the info we need!! HUGS!!!
Sandy, I don’t expect the Watch to be part of the conversation. There is certainly no way to monitor its use and it is really just an extension of the phone. In the future the watch may be able to stand alone but hopefully it’s use will not be forbidden. At some point if we are using the receiver “in conjunction” with those devices, I would hope that we would be in compliance. But I wait for the final regulations with a little bit of trepidation….
I 11th that, thanks for this vital info.
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Any update on this?
Yes, Noridian released this document on June 21. Some people are waiting until Dexcom releases an interpretation, but many of us are already using smartphones. Because the ruling says in conjunction with the receiver, my receiver is on the kitchen counter getting readings when I am at home. But I am not carrying it. I think I am in compliance but will remain alert to more policy updates. https://med.noridianmedicare.com/web/jadme/policies/dmd-articles/continuous-glucose-monitors-use-of-smart-devices
Laddie, thanks for this article and update. Are you using the Clarity app on your iPhone along with your Dex app? And/or are you uploading your receiver on your computer online to Clarity?
Sue-I am using the Dexcom G5 app on my phone and will periodically download to my laptop my receiver which lives on my kitchen counter. I have the Clarity app on my phone but don’t use it. I prefer to look at Clarity on my laptop which has a much bigger screen. I have also set up SugarMate as a follower in my Dex account. SugarMate uses the calendar app to send readings to the Apple Watch and it is much more reliable at having updated numbers than the Dex app.
When I saw your blog and then Rick Teal’s reply to me in Seniors with Sensors I restarted my receiver and like you and Rick will keep it running in the background. I guess I’ll also continue to upload to the Clarity website on my Mac. I put the SugarMate app on my iPhone last week and then my watch. It worked intermittently. I followed your suggestion to remove any calendars other than the SugarMate from iCloud, as well as other suggestions on Seniors with Sensors and the the app itself, and it still only worked intermittently so I decided it wasn’t worth all I time I was wasting and removed it from my watch but I still have it on my iPhone.
NOW allows it.