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Diabetes Self-Management Training Initiative

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Background

About 27% of Medicare beneficiaries have diabetes, and the percentage is even higher among minority populations. Studies have proven that effective management of diabetes decreases mortality and morbidity and may lower future medical care costs. Part B of original Medicare has a Diabetes Self-Management Training (DSMT) benefit designed to educate beneficiaries with a diagnosis of diabetes about their disease and how to better manage it.

The U.S. Administration on Aging (AoA), now part of the Administration for Community Living, implemented the “DSMT Reimbursement Initiative” a few years ago to increase access to this important benefit by focusing on its financial sustainability.

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Goal and Progress

The original goal of this initiative was to assist Area Agencies on Aging (AAAs) and their Medicare service provider partners in achieving accreditation from American Diabetes Association (ADA) or American Association of Diabetes Educators (AADE) to offer a DSMT program using an evidence-based diabetes self-management program as the curriculum. Accredited programs can receive Medicare recognition and subsequent claims reimbursement, and can be self-sustaining when combined with the Medicare medical nutrition therapy benefit.

As of early 2013, a handful of AAAs in the initiative have achieved accreditation and are receiving claims reimbursement. This is a moving target, as more sites from the original cohort achieve the sequential milestones.

This Reimbursement Initiative has ended. Although AoA is no longer accepting requests from individual AAAs to provide technical assistance on setting up Medicare-reimbursable DSMT programs outside of our current grant programs, we continue to support this effort with general technical assistance. The DSMT Toolkit is an example of this assistance.

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DSMT Toolkit

We developed a DSMT Toolkit to provide AAAs, community planners, and healthcare professionals with valuable information and insights that can help them operate cost-effective, accredited DSMT programs that can meet CMS requirements for Medicare reimbursement. Links to the complete toolkit, as well as to the individual chapters, and instructions for obtaining a Medicare Provider Number can be found below.

DSMT Toolkit (PDF, 804KB), updated April 2013

Individual Chapters (identical to the chapters from the full toolkit)

  1. Prevalence of Diabetes
  2. Key Definitions
  3. Medicare DSMT Benefit Overview
  4. Medical Nutrition Therapy Benefit
  5. Medicare Billing Detail
  6. The Role of Area Agencies on Aging and Community Partners in Providing DSMT Programs
  7. CMS Approved Accrediting Organizations
  8. Ten National Standards for Diabetes Self-Management Education
  9. AADE Accreditation Guidelines
  10. ADA Accreditation Guidelines
  11. Required Program Infrastructure for Stanford Model Programs
  12. Role of the Program Coordinator
  13. Program Licensed Instructors
  14. Conducting a Needs Assessment
  15. Business Planning
  16. Program Budget Planning
  17. Break-Even Analysis
  18. Program Income Calculation Sample
  19. Sample Revenue Projection per Class
  20. Working with a Medicare Provider Partner
  21. Consumer Enrollment Process
  22. Program Evaluation and Continuous Quality Improvement
  23. How to Work with a Federally Qualified Health Center (FQHC)
  24. Business Plan Case Study
  25. Sample AADE Chart Auditor Checklist
  26. Sample Physician Order—DSMT and/or MNT Services
  27. Sample AADE Application
    1. Standard 1
    2. Standard 2
    3. Standard 3
    4. Standard 4
    5. Standard 5
    6. Standard 6
    7. Standard 7
    8. Standard 8
    9. Standard 9
    10. Standard 10

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Other Helpful DSMT Resources

Many other resources are available to help you learn more about DSMT accreditation and Medicare reimbursement. To learn more, click here or go to the links below to access specific resources.

Frequently Asked Questions

Webinars

Tip Sheets

Other Resources

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Last Modified: 12/31/1600