Diabetes Self-management Education and Support in T2D
Diabetes Self-management Education and Support in T2D
Reimbursement for DSME/S is available from the Centers for Medicare and Medicaid Services (CMS) and many private payers. Additional discipline-specific counseling, such as medical nutrition therapy (MNT) provided by a registered dietitian nutritionist, medication therapy management delivered by pharmacists, and psychosocial counseling offered by mental health professionals, is also reimbursed through CMS and/or third-party payers.
In order to be eligible for DSME/S reimbursement, DSME/S programs must be recognized or accredited by a CMS-designated national accreditation organization (NAO). Current NAOs are the ADA and the American Association of Diabetes Educators (AADE). Both bodies assess the quality of programs using criteria established by the National Standards for DSME/S (Table 2). Currently, CMS reimburses for 10 program hours of initial diabetes education and 2 hours in each subsequent year. Referrals for DSME/S must be made by a health care provider and include specified indicators, such as diabetes type, treatment plan, and reason for referral. Sample referral forms with information needed for reimbursement are available on the ADA Web site (http://professional.diabetes.org/Recognition.aspx?typ=15&cid=93574) and the AADE Web site (http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/general/Diabetes_Services_Order_Form_v4.pdf).
According to the National Standards for DSME/S, at least one instructor responsible for designing and planning DSME/S must be a nurse, dietitian, pharmacist, or other trained or credentialed health professional (a certified diabetes educator [CDE] or health care professional with Board Certified-Advanced Diabetes Management [BC-ADM] certification) (Table 1) who meets specific competency and continuing education requirements. This person is considered the primary instructor. Others can contribute to DSME and provide support with appropriate training and supervision. Trained community health workers, practice-based care managers, peers, and other support persons (e.g., family members, social workers, and mental health counselors) have a role in helping to sustain the benefits gained from DSME. Such staff/resources can be especially helpful in areas with diverse populations and serve as cultural navigators in health care systems and as liaisons to the community.
As an alternative to a referral to a formal DSME/S program, office-based health care teams can explore partnerships with educators within their community or assume responsibility for providing and/or coordinating some or all of the patient's diabetes education and support needs. Although this approach requires knowledge, time, and resources to effectively provide education, it offers a unique opportunity to reach patients at the point of care. This position statement and the National Standards for DSME/S are designed to serve as a resource for the health care team. Although reimbursement for education services is somewhat limited, financial benefits can be realized when an office-based program contributes to improved practice processes and patients' achievement of outcomes that can influence mandated quality measures.
Reimbursement, National Standards, and Referral
Reimbursement for DSME/S is available from the Centers for Medicare and Medicaid Services (CMS) and many private payers. Additional discipline-specific counseling, such as medical nutrition therapy (MNT) provided by a registered dietitian nutritionist, medication therapy management delivered by pharmacists, and psychosocial counseling offered by mental health professionals, is also reimbursed through CMS and/or third-party payers.
In order to be eligible for DSME/S reimbursement, DSME/S programs must be recognized or accredited by a CMS-designated national accreditation organization (NAO). Current NAOs are the ADA and the American Association of Diabetes Educators (AADE). Both bodies assess the quality of programs using criteria established by the National Standards for DSME/S (Table 2). Currently, CMS reimburses for 10 program hours of initial diabetes education and 2 hours in each subsequent year. Referrals for DSME/S must be made by a health care provider and include specified indicators, such as diabetes type, treatment plan, and reason for referral. Sample referral forms with information needed for reimbursement are available on the ADA Web site (http://professional.diabetes.org/Recognition.aspx?typ=15&cid=93574) and the AADE Web site (http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/general/Diabetes_Services_Order_Form_v4.pdf).
According to the National Standards for DSME/S, at least one instructor responsible for designing and planning DSME/S must be a nurse, dietitian, pharmacist, or other trained or credentialed health professional (a certified diabetes educator [CDE] or health care professional with Board Certified-Advanced Diabetes Management [BC-ADM] certification) (Table 1) who meets specific competency and continuing education requirements. This person is considered the primary instructor. Others can contribute to DSME and provide support with appropriate training and supervision. Trained community health workers, practice-based care managers, peers, and other support persons (e.g., family members, social workers, and mental health counselors) have a role in helping to sustain the benefits gained from DSME. Such staff/resources can be especially helpful in areas with diverse populations and serve as cultural navigators in health care systems and as liaisons to the community.
As an alternative to a referral to a formal DSME/S program, office-based health care teams can explore partnerships with educators within their community or assume responsibility for providing and/or coordinating some or all of the patient's diabetes education and support needs. Although this approach requires knowledge, time, and resources to effectively provide education, it offers a unique opportunity to reach patients at the point of care. This position statement and the National Standards for DSME/S are designed to serve as a resource for the health care team. Although reimbursement for education services is somewhat limited, financial benefits can be realized when an office-based program contributes to improved practice processes and patients' achievement of outcomes that can influence mandated quality measures.
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