Diabetes Self-Management Education and Support
Increase Access to Diabetes Management Services
DSMES is an evidence-based foundation that provides participants with the knowledge and support needed to better manage and navigate through daily challenges of living with diabetes conditions. DSMES services have been shown to improve health outcomes of residents living with diabetes.
DSMES services are typically delivered in person, in small groups, or in a classroom-based setting. Some organizations—particularly those in rural locations—also deliver DSMES via telehealth.
Benefits of DSMES program participation includes:
- Improved A1C levels
- Higher rates of medication adherence
- Decreased rate and less severe diabetes-related complications
- Improved patient confidence and self-care ability
- Decreased healthcare costs
Find DSMES Services Near You
Use the Well-Ahead Community Resource Guide to find DSMES services in your area.
Learn from a wide range of diabetes specialists to help your patients living with diabetes manage their conditions and earn continuing education credits for participating!
Starting DSMES Services at Your Facility
Implementing DSMES services can ensure that your patients living with diabetes receive quality, evidence-based care and education to help them better manage their diabetes and improve their health behaviors.
Before implementation, the DSMES program must be recognized through the American Diabetes Association (ADA) or accredited through the Association of Diabetes Care and Education Specialists (ADCES). An accredited program may be reimbursed by Medicare, many private health plans and some state Medicaid agencies. Each of these certifying associations base their accreditation/recognition process on the same standards that are updated every 5 years in a joint effort through Centers for Medicare and Medicaid Services (CMS), ADA and ADCES.
Well-Ahead can assist you through the application process and provide technical assistance. To request technical assistance or additional information, fill out the form at the bottom of this web page.
The initial application process for accreditation/recognition requires implementation and documentation for each of the required 10 Standards. For additional details on each standard and what needs to be submitted for review, click here.
- Independent healthcare clinics
- Rural health clinics
- Federally qualified health centers
- Patient-centered medical homes
- Home health agencies
- Skilled nursing homes
- Community-based organizations
- Community centers
- Faith-based organizations
- Area Agencies on Aging
- Durable medical equipment companies
- Assisted living facilities
- Must be newly diagnosed with diabetes (Type 1 or 2), gestational diabetes, pregnant with a history of diabetes, or never received diabetes education after being diagnosed.
- Must demonstrate poor glycemic control (A1C >7).
- Must have had an acute episode of severe hypoglycemia or hyperglycemia occurring in the past 12 months.
- Must have received a diagnosis of a complication, a diagnosis of a co-morbidity, or prescription for new equipment such as an insulin pump.
For Medicare reimbursement, DSMES services cannot be provided in inpatient hospital settings nor End Stage Renal Disease (ESRD) facilities. A quality coordinator will be designated to ensure the implementation of the Standards and oversee the DSMES program.
- Registered nurse (RN)
- Registered dietitian/nutritionist (RDN)
- Pharmacist with training and experience pertinent to DSMES
- Other healthcare professionals holding a CDE or BC-ADM
For Medicare reimbursement, DSMES telehealth services must be provided by a qualified DSMES provider who is also one of the following provider types:
- Nurse Practitioners
- Physician Assistants
- Nurse Midwives
- Certified Nurse Specialists
- Certified Registered Nurse Anesthetists
- Clinical Phycologists
- Clinical Social Workers
- Registered Dieticians or Nutrition Professionals
Louisiana Medicaid does not limit the providers that can provide services via telehealth. Each licensing board (LSBME, Board of Nursing, etc.) can limit their provider’s ability to deliver services via telehealth.
For billing purposes, make sure that services are provided by a healthcare provider who is qualified to bill the relevant payer for services provided via telehealth.
Healthcare providers must utilize the below billing codes:
- The same code as in-person visits would be utilized (G0108 and G0109) with the place of service code of “02” which indicates a telemedicine visit, for both MEDICARE and MEDICAID billing.
- For MEDICARE, the “-GT” modifier should be appended to the relevant codes if billing under CAH Option Payment Method II.
- For MEDICAID, the “-95” modifier should also be appended to all relevant CPT codes to indicate that the service was provided via telemedicine. RHCs should also include the modifier on the header line.
After an application to start a DSMES as been submitted:
- An initial application fee of $1,100 is paid for a 4-year period.
- Review of the application can take up to 30 days
- Applications requiring additional information and/or corrections during review process may take longer than 30 days to complete review
- A Quality coordinator will be notified via email when an application has been approved or returned for additional documentation
Join LaDEN and Receive Technical Assistance!
The Louisiana Diabetes Educators Network (LaDEN) is comprised of diabetes care and education specialists, including nurses, dietitians, mid-level practitioners, pharmacists and exercise physiologists who work collaboratively with other healthcare professionals.