SUBJECT: Diabetes Self-Management Training (DSMT) Certified Diabetic Educator

Transcription

1 anual ystem Pub edicare Benefit Policy Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 109 Date: UGUT 7, 2009 hange equest 6510 UBJT: Diabetes elf-anagement Training (DT) ertified Diabetic ducator. UY O NG: The purpose of this transmittal is to allow for an exception for rural areas and to recognize an approved national accreditation organization. n a rural area, an individual who is qualified as a registered dietitian and as a certified diabetic educator that is currently certified by an organization approved by may furnish training and is deemed to meet the multidisciplinary team requirement. The edicare Program: pplication by the merican ssociation of Diabetes ducators (D) for ecognition as a National ccreditation Organization for ccrediting ntities to urnish Outpatient Diabetes elf-anagement Training (DT) final rule was released. t was published in the ederal egister on ebruary 27, 2009, Volume 74, effective arch 30, 2009; determined that the D is recognized as an approved national accreditation organization to furnish DT. Providers/suppliers of DT services may submit requests for accreditation and edicare contractors shall recognize the D. New / evised aterial ffective Date: arch 30, 2009 mplementation Date: eptember 8, 2009 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NG N NUL NTUTON: (N/ if manual is not updated) =VD, N=NW, D=DLTD /N/D PT/TON/UBTON/TTL 15/300/300.2/ertified Providers. UNDNG: TON : or iscal ntermediaries and arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets.

2 TON B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTNT: Business equirements anual nstruction *Unless otherwise specified, the effective date is the date of service.

3 ttachment - Business equirements Pub Transmittal: 109 Date: ugust 7, 2009 hange equest: 6510 UBJT: Diabetes elf-anagement Training (DT) ertified Diabetic ducator ffective Date: arch 30, 2009 mplementation Date: eptember 8, GNL NOTON. Background: Pub , edicare Benefit Policy, hapter 15, overed edical and Other ealth ervices is amended to clarify that there is an exception for who can provide DT in a rural area. n the release of the edicare Program: pplication by the merican ssociation of Diabetes ducators (D) for ecognition as a National ccreditation Organization for ccrediting ntities to urnish Outpatient Diabetes elf-anagement Training (DT) final rule published in the ederal egister on ebruary 27, 2009, Volume 74, effective arch 30, 2009, the enters for edicare & edicaid ervices () determined that the merican ssociation of Diabetes ducators (D) is recognized as an approved national accreditation organization to furnish Diabetes elf anagement Training (DT). Providers and suppliers of DT services may submit requests for accreditation through the D and edicare contractors shall recognize the D as an approving entity for the DT program billable through edicare. B. Policy: (a)(4)()(ii) describes the exception for rural areas. n a rural area, an individual who is qualified as a registered dietitian and as a certified diabetic educator that is currently certified by an organization approved by may furnish training and is deemed to meet the multidisciplinary team requirement.. BUN QUNT TBL Use hall" to denote a mandatory requirement Number equirement esponsibility (place an X in each applicable column) The contractor shall allow an individual who is qualified as a registered dietitian and as a certified diabetic educator, currently certified by an organization approved by, to furnish training and is deemed to meet the multidisciplinary team requirement ffective arch 30, 2009, edicare contractors shall accept approved merican ssociation of Diabetes ducators (D) accreditation certificates from providers wishing to bill for DT services ontractors shall reprocess previously disapproved valid D certificates if brought to contractor attention. / B D hared-ystem aintainers V W OT

4 . POVD DUTON TBL Number equirement esponsibility (place an X in each applicable column) provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within 1 week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. / B D hared-ystem aintainers V W OT V. UPPOTNG NOTON ection : or any recommendations and supporting information associated with listed requirements: Use "hould" to denote a recommendation. X-ef equirement Number ecommendations or other supporting information: ection B: or all other recommendations and supporting information: V. ONTT Pre-mplementation ontact: Terri arris Post-mplementation ontact: Terri arris V. UNDNG ection : or iscal ntermediaries (s), egional ome ealth ntermediaries (s) and/or arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets.

5 ection B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the contracting officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the contracting officer, in writing or by , and request formal directions regarding continued performance requirements.

6 ertified Providers (ev. 109; ssued: ; ffective Date: ; mplementation Date: ) designated certified provider bills for DT provided by an accredited DT program. ertified providers must submit a copy of their accreditation certificate to the contractor. The statute states that a certified provider is a physician or other individual or entity designated by the ecretary that, in addition to providing outpatient selfmanagement training services, provides other items and services for which payment may be made under title XV, and meets certain quality standards. The is designating all providers and suppliers that bill edicare for other individual services such as hospital outpatient departments, renal dialysis facilities, physicians and durable medical equipment suppliers as certified. ll suppliers/providers who may bill for other edicare services or items and who represent a DT program that is accredited as meeting quality standards can bill and receive payment for the entire DT program. egistered dietitians are eligible to bill on behalf of an entire DT program on or after January 1, 2002, as long as the provider has obtained a edicare provider number. dietitian may not be the sole provider of the DT service. There is an exception for rural areas. n a rural area, an individual who is qualified as a registered dietitian and as a certified diabetic educator who is currently certified by an organization approved by may furnish training and is deemed to meet the multidisciplinary team requirement. The will not reimburse services on a fee-for-service basis rendered to a beneficiary under Part. NOT: While separate payment is not made for this service to ural ealth linics (s), the service is covered but is considered included in the all-inclusive encounter rate. ffective January 1, 2006, payment for DT provided in a ederally Qualified ealth linic (Q) that meets all of the requirements identified in Pub , chapter 18, section 120 may be made in addition to one other visit the beneficiary had during the same day. ll DT programs must be accredited as meeting quality standards by a approved national accreditation organization. urrently, recognizes the merican Diabetes ssociation, merican ssociation of Diabetes ducators and the ndian ealth ervice as approved national accreditation organizations. Programs without accreditation by a -approved national accreditation organization are not covered. ertified providers may be asked to submit updated accreditation documents at any time or to submit outcome data to an organization designated by. nrollment of DPO uppliers The DPO suppliers are reimbursed for diabetes training through local carriers. n order to file claims for DT, a DPO supplier must be enrolled in the edicare program with the National upplier learinghouse (N). The supplier must also meet the quality standards of a -approved national accreditation organization as stated

7 above. DPO suppliers must obtain a provider number from the local carrier in order to bill for DT. The carrier requires a completed orm -855, along with an accreditation certificate as part of the provider application process. fter it has been determined that the quality standards are met, a billing number is assigned to the supplier. Once a supplier has received a National Provider dentification (NP) number, the supplier can begin receiving reimbursement for this service. arriers should contact the National upplier learinghouse (N) according to the instruction in Pub , the edicare Program ntegrity anual, hapter 10, ealthcare Provider/upplier nrollment, to verify an applicant is currently enrolled and eligible to receive direct payment from the edicare program. The applicant is assigned specialty 87. ny DPO supplier that has its billing privileges deactivated or revoked by the N will also have the billing number deactivated by the carrier.