AADE-Accredited or ADA-Recognized Diabetes Self-Management Education/Training (DSME/T)

Definitions, Structure, and Resources to Get You Started

Definitions

Diabetes Self-Management Education (DSME) includes all education programs regardless of whether they are accredited/recognized or not and/or whether they bill insurance or not.

Diabetes Self-Management Education and Support (DSME/S) refers to a program that includes education (DSME) and support (DSMS).

Diabetes Self-Management Support (DSMS) includes ongoing support that has been identified as a key to ongoing self-management for diabetes. Patients must identify, with instructor assistance if needed, a community source of ongoing support. The instructor must document this in the patient’s record.

Diabetes Self-Management Training (DSMT) implies that the program is accredited or recognized and has also applied to Medicare for a National Provider Identifier (NPI) number and is billing Medicare and other insurance for reimbursement. In Medicare coverage documents and often in other insurers’ coverage policies, the term DSMT is used. Per Centers for Medicare & Medicaid Services (CMS) Policy, a DSME program must be accredited or recognized by either the American Association of Diabetes Educators (AADE) or the American Diabetes Association (ADA) to be able to apply to CMS to be reimbursable. Physician order forms for diabetes education should use the term DSMT or spell it out, to follow Medicare language.

Structure

How do DSMP and DEEP fit in to all this? Can these be AADE-Accredited or ADA-Recognized, and therefore potentially reimbursed by Medicare?

DEEP and DSMP are pre-approved curricula by CMS for Everyone with Diabetes Counts (EDC) since evidence shows they are effective in community settings. A curriculum that meets the Ten National Standards for DSME/S is one key component of a quality DSME program. Both DEEP and DSMP meet Standard 6 for an evidence-based curriculum. However, the other nine Standards for DSME programs must also be met before a program is eligible to become AADE-Accredited or ADA-Recognized.

Ten National Standards for DSME/S (will be referred to below as the Ten Standards)

Both AADE and ADA require their programs to meet the Ten Standards. The tools and checklists below can be extremely helpful in setting up and ensuring the needed elements are covered and submitted. It is recommended that the most updated version of the Ten Standards document be kept at hand throughout this process to continue adhering to the standards.

Click here for the 2012 version.

Being Accredited by the American Association of Diabetes Educators vs. Being Recognized by the American Diabetes Association

The core components are the same for both organizations. Renewal is on a four-year cycle, and the price is also very similar. Both programs do audits to ensure standards are being met. A Continuous Quality Improvement (CQI) plan must be developed and submitted for both in the initial and renewal applications, but first reporting of outcomes does not start until one year after initial accreditation or recognition.

AADE-Accreditation

Application Assistance Links: https://www.diabeteseducator.org/practice/diabetes-education-accreditation-program-(deap)/applying-for-accreditation

Essential Elements Checklist with Interpretive Guidance: Crosswalk for AADE’s Diabetes Education Accreditation Program

Checklist for Required Documentation to Meet All Ten Standards of DSME/S: https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/accred/Supporting_Documents_CheckList-2013.pdf

To reach more patients, an established program may work with a community site (such as an Area Agency on Aging, library, etc.) or a satellite site of the existing healthcare entity. Prior to applying for additional sites to become accredited/recognized and to bill, the main location must be accredited or recognized, and the entity and/or at least one provider must already be billing Medicare for another service. A DSMT provider is a person who can bill on behalf of the entire program and is a registered dietitian, physician, PA, NP, CNS, LCSW, or clinical psychologist. These individuals may also teach in the program but each program must also contain at least one RD, RN, or pharmacist.

Community Site Branch LocationNo fee to AADE $100 fee per location to AADE, for administrative oversightDoes not have to be same entity as main location

Establishments within same healthcare entity

Does not bill; Billing goes through main location

May bill separately

Same program with modifications for target population needs

Same program with modifications for target population needs

Up to 10 sites, all within same state as main location

Up to 30 locations, all within same state as main location

No certificate needed; no separate location posted on web

Receives own certificate with same ID number and name of main location with optional qualifier to allow for separate billing; location is listed separately on AADE’s website

ADA-Recognition

ADA also has provisions for existing recognized programs to reach more patients through adding sites, called Expansion Sites and Multi-Sites.

List of Requirements (ADA’s version of the AADE-Crosswalk) http://professional.diabetes.org/admin/UserFiles/2014%20ERP/9th-edition-recognition-requirements.pdf

ADA’s Expansion Site has the same definition as AADE’s Community Site, but with ADA, a program can have an unlimited number of Expansion Sites.

ADA’s Multi-Site is the same as AADE’s Branch Location. Multi-sites operate semi-independently of the primary program. A Multi-Site has the option to use the same or different staff, curriculum, CQI, policies/procedures, forms, and billing.

DiabetesPro.org ADA-ERP There are more related documents

Here are two key standards, which relate to required staff:

Standard 4: Explains requirements for the program coordinator. The program coordinator needs to be someone with knowledge about managing a chronic disease and facilitating behavior change, and needs to have experience with program and/or clinical management. In small programs or practices, the coordinator may also provide the DSME/S. Note: this person does not have to be a CDE, though having a CDE is beneficial to understanding the needs of employees and of people with diabetes being served.

Standard 5: Key for EDC programs to meet the qualification standards of instructional staff and curriculum development and/or revision. Instructional staff: One or more instructors will provide DSME and, when applicable, DSMS. At least one of the instructors responsible for designing and planning DSME and DSMS will be a registered nurse, registered dietitian, or pharmacist with training and experience pertinent to DSME, or another professional with certification in diabetes care and education, such as a CDE or BC-ADM. Other health workers can contribute to DSME and provide DSMS with appropriate training in diabetes and with supervision and support. The literature favors the registered nurse, registered dietitian, and pharmacist serving both as the key primary instructors for diabetes education and as members of the multidisciplinary team responsible for designing the curriculum and assisting in the delivery of DSME (1–7,68). Expert consensus supports the need for specialized diabetes and educational training beyond academic preparation for the primary instructors on the diabetes team (69–72). Note that per Medicare and the Ten Standards, at least one instructor needs to be an RN, RD, or pharmacist with pertinent training and experience in diabetes, or they are already a CDE or BC-ADM, indicating they have had practice hours and passed a certification exam. That person does not have to be the Program Coordinator, but may be.

Billing: Where to Start

Once certified either with AADE or ADA, you can work toward billing Medicare. Your program can apply for an NPI number, or you can bill under the professional that already has an NPI. The accreditation process through AADE or recognition process through ADA is essential to obtain Medicare reimbursement for DSMT. However, it is a separate process and does not guarantee Medicare payment. In addition to the accreditation process, a DSMT program should do the following:

• Sponsoring organization must have an NPI number as well as be enrolled as a Medicare provider for services other than DSM

• NPI application forms: https://nppes.cms.hhs.gov or for paper application, call 800-465-3203

• If new to Medicare, need to submit Form 855I to enroll as a Medicare provider (obtain forms through local Medicare Administrative Contractor (MAC))

• Pharmacy and Durable Medical Equipment providers must also enroll as a Part B provider to bill for DSMT service

• Must submit notice of AADE accreditation or ADA Recognition to your local Medicare Administrative Contractor (MAC)

• Confirm that the HCPCS codes for billing DSMT are loaded in billing system (G0108 and G0109)

• Submit accreditation notice to contracted commercial payers and verify that DSMT codes G0108 and G0109 are included in contract

Don’t stop with Medicare. If your state M.A. Plans and/or Medicaid covers DSME/T, go through the appropriate processes for these as well. Many commercial insurance plans also cover DSME/T. You will want to be set up for as many as are covering DSME to maximize your sustainability.

References/Resources:

1. Ten National Standards for DSME/S, Diabetes Care, 2012 http://professional.diabetes.org/admin/UserFiles/2012%20ERP/2012-revised-standard-final.pdf

2. AADE-DEAP site: https://www.diabeteseducator.org/practice/diabetes-education-accreditation-program-(deap)/applying-for-accreditation (includes National Standards, samples of required documents listed by standard, checklist for supporting documents, site descriptions, link to CMS NPI # application)

3. ADA-ERP site: @http://professional.diabetes.org/diabetes-education (includes National Standards and requirements and resources to assist in setting up and maintaining recognition, including a CQI Toolkit)

4. DSMT and MNT Order Form: https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/Diabetes_Services_Order_Form_v4.pdf (includes elements CMS requires on DSMT orders)

5. How DSMT and MNT can be coordinated for qualifying Medicare beneficiaries: https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/Diabetes_Services_Order_Form_Backgrounder__Final.pdf (MNT services together with DSMT to increase likelihood for financial viability)

6. Outcomes Measurement in DSME: https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/research/outcome_measurement_position_statement_2011.pdf?sfvrsn=2 (Be sure to view the figure and table after references pp. 11-13)

7. American Diabetes Association, Standards of Medical Care in Diabetes, Diabetes Care, 39:1, S01-S112, 2016: @ http://professional.diabetes.org/content/clinical-practice-recommendations

8. Critical times to refer to for DSME and associated key learning needs cited from Powers, MA, Bardsley, J, Cypress, M, et al. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics, Diabetes Care 2015; 38:1372-1382: https://www.diabeteseducator.org/docs/default-source/practice/practice-resources/position-statements/dsme_joint_position_statement_2015.pdf?sfvrsn=0

9. Examples of appropriate participant-created goals: @ http://professional.diabetes.org/sites/professional.diabetes.org/files/media/erp-sample-behavior-change-objectives.pdf DEEP and DSMP curricula/training (also contains behavior change goal-setting)

10. Example form: Diabetes Self-Management Support Plan: http://professional.diabetes.org/sites/professional.diabetes.org/files/media/erp-sample-DSMS-plan.pdf

11. Practice Levels for Diabetes Educators and Paraprofessionals, AADE, 2016, Original Publication 2014: @ https://www.diabeteseducator.org/docs/default-source/practice/practice-resources/praclev2016.pdf?sfvrsn=2

12. Competencies for Diabetes Educators and Paraprofessionals, 2016: https://www.diabeteseducator.org/docs/default-source/practice/practice-resources/comp003.pdf?sfvrsn=2

13. (FQHC and RHCs) Medicare Benefit Policy Manual, Chapter 13 RHC and FQHC Services: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c13.pdf

14. (Fee-for-Service) Medicare Benefits Policy Manual (Chapter 15, Section 300): https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf

15. (Fee-for-Service, Brochure for Beneficiaries) Medicare’s Coverage of Diabetes Supplies and Services, Centers for Medicare and Medicaid Services, CMS Product No. 11022, Revised September 2013: https://www.medicare.gov/Pubs/pdf/1102.pdf

16. A provider toolkit for screening and referring to DSME: http://nevadawellness.org/wp-content/uploads/2015/06/6349-NV-Wellness_DSME-Toolkit_C1R4F.pdf

17. A provider toolkit for screening and referring to diabetes prevention programs: http://www.cdc.gov/diabetes/prevention/pdf/STAT_toolkit.pdf

This material was prepared by Telligen, the Quality Innovation Network National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QINNCC-00867-06/20/16