Updates to the Therapeutic Shoes for Persons with Diabetes LCD

In case you did not attend, there was a webinar held by CGS reviewing the updates to the Therapeutic Shoes for Persons with Diabetes LCD.
The main updates/changes relating to the ability for NPs/PAs were discussed in further detail. The presentation slides are attached, and below is a recap of the key changes –

• NPs and PAs can now author the Diabetes Exam Note (in place of the MD/DO); however, the MD/DO still needs to acknowledge, agree, and sign off on their findings. This update applies to everyone nationwide if the NP/PA meets the “incident to” requirements.
• “Incident to” refers to an NP/PA “employed by the physician and under the physician’s personal supervision” and does not apply if the NP/PA is working independently
• In this scenario, the MD/DO and the NP/PA will both be responsible for signing the Foot Exam and Certifying Statement.
• Diabetes Exam Note must be dated after the policy update was released (on 11/5 or sooner)

• The Primary Care First Model, which applies to only specific regions, will allow for NPs working independently to completely fulfill the role of the MD/DO
• NP will need to have had applied to be part of the PCF demonstration project (list attached).
• 26 regions: Alaska (statewide), Arkansas (statewide), California (statewide), Colorado (statewide), Delaware (statewide), Florida (statewide), Greater Buffalo region (New York), Greater Kansas City region (Kansas and Missouri), Greater Philadelphia region (Pennsylvania), Hawaii (statewide), Louisiana (statewide), Maine (statewide), Massachusetts (statewide), Michigan (statewide), Montana (statewide), Nebraska (statewide), New Hampshire (statewide), New Jersey (statewide), North Dakota (statewide), North Hudson-Capital region (New York), Ohio and Northern Kentucky region (statewide in Ohio and partial state in Kentucky), Oklahoma (statewide), Oregon (statewide), Rhode Island (statewide), Tennessee (statewide), and Virginia (statewide).
  

Resources –

• DME Mac Article - Nurse Practitioners and Physician Assistants as Certifying Physicians for Therapeutic Shoes and Inserts
• Primary Care First Model
• Full LCD Policy Article