May 28, 2003 - The Centers for Medicare and Medicaid Services (CMS) has issued a Program Memorandum to Carriers on diabetes self-managment training.

Diabetes Outpatient Self-Management Training (DSMT) and the "Incident to" Provision - Transmittal B-03-043


October 25, 2002 - The Centers for Medicare and Medicaid Services (CMS) has issued a Program Memorandum to Intermediaries and Carriers on outpatient self-management training for diabetes:

"Clarification Regarding Non-physician Practitioners Billing on Behalf of a Diabetes Outpatient Self-Management Training Services (DSMT) Program and the Common Working File Edits for DSMT & Medical Nutrition Therapy (MNT). (NOTE: APASS has received a waiver for this CR)" - Transmittal AB-02-151

October 14, 2002 - The Centers for Medicare and Medicaid Services (CMS) has issued a Program Memorandum to Carriers on outpatient self-management training for diabetes:

"Payment to Registered Dietitians for Diabetes Outpatient Self-Management Training (DSMT) Services" - Transmittal B-02-062

August 29, 2002 - A study published in the September 2002 issue of the American Journal of Kidney Diseases (AJKD) reports on the positive impact of diabetes education and training in a dialysis facility.

"Diabetes education and care management significantly improve patient outcomes in the dialysis unit" - abstract from AJKD
Patients in the study group that received intensive diabetes education and care management in a dialysis unit enjoyed significantly improve patient outcomes including fewer foot problems, fewer amputations, fewer hospitalizations, and higher quality of life scores.

January 10, 2002 - The US Government has updated its booklet on Medicare coverage for dialysis patients. Starting on January 1, 2002, glaucoma screening (once per year) is covered (80%) for those with diabetes or a family-history of glaucoma.

Here is the pdf file link for the booklet entitled "Medicare Coverage of Kidney Dialysis and Kidney Transplant Services". See page 41 (of 58) for an overview of the glaucoma coverage.

October 1, 2001 - The CDC MMWR web site has released a report regarding diabetes self-management education:

"Strategies for Reducing Morbidity and Mortality from Diabetes Through Health-Care System Interventions and Diabetes Self-Management Education in Community Settings" - report from Sept. 28 MMWR

August 7, 2001 - CMS/HCFA has released a Program Memorandum entitled, "Correction of Payment for Diabetes Outpatient Self-Management Training Services".

Here is Program Memorandum AB-01-109, effect August 3, 2001. (link is no longer available)

January 4, 2001 - HCFA has released the final rule and notice of the "Expanded Coverage for Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements". (link is no longer available)

In April of 1999, the National Renal Administrator's Association (NRAA) submitted comments to the Health Care Financing Administration (HCFA) on a proposed rule that would allow dialysis facilities to receive Medicare reimbursement for outpatient diabetes self-management training. (link is no longer available

Here are some highlights from the HCFA regulations:

Comment: Several commenters stated that end stage renal disease (ESRD) facilities fall under the definition of approved entities that furnish outpatient diabetes training. The commenters recommend that a method be established to ensure that dialysis facilities can be directly paid under this initiative.

Response: The requirements in Sec. 414.63 state that payment for outpatient diabetes self-management training is made under the physician fee schedule. We agree, however, that these facilities that are not normally paid under the physician fee schedule may qualify to be an approved entity if they meet all the criteria for providing this service. In this final rule, we added a new Sec. 414.63(d), to provide for "Payments made to those not paid under the physician fee schedule". ESRD facilities that qualify will bill the fiscal intermediary for these services using the appropriate HCFA Common Procedure Coding System (HCPCS) codes. The same quality standards and other requirements apply in any setting. The payment amount for a qualifying ESRD facility will be the same as the amount established for an entity paid by a carrier.

J. Payment for Outpatient Diabetes Self-Management Training Services - In accordance with section 4105(a) of the BBA, we proposed in Sec. 414.63 that Medicare payment for outpatient diabetes self-management training would be made under the physician fee schedule described in Sec. 414.1 through 414.48. Section 1848 of the Act requires that payments under the physician fee schedule be based on national uniform relative value units (RVUs) that are based on the resources used in furnishing a service. We proposed in the preamble of the February 1999 proposed rule to pay $55.41 (using the proposed RVUs) for individual sessions and $32.62 per person within a group session. We stated that these same payment rates would apply for the 1-hour annual refresher training. We also stated that actual payments to an entity approved by us would be adjusted for geographic variation and determined based on the physician fee schedule methodology as described in a separate final rule published in the Federal Register on October 31, 1997 (62 FR 59048).


Comment: Several commenters suggested that we cover core diabetes education for Medicare beneficiaries once in a lifetime, not to exceed $330, and follow-up visits, if needed, not to exceed $170 per year. By limiting the dollar amount instead of the number of hours, these commenters suggest that clinicians could take responsibility for customizing a cost-effective treatment plan to best meet the needs of the patient. For example, $330 could be used for 6 hours of individual training or 10 hours of classroom training. It would save time,paperwork, and preserve the Medicare budget.

Response: Under the proposed rule, payment is made for training sessions actually attended by the beneficiary and not for packages of training sessions. We believe this payment methodology is important to ensure that needed training is received and to give us information that we can later use to evaluate the effectiveness of the benefit. Therefore, in Sec. 414.63(c), we retain the requirement that payment is made for training sessions actually attended by the beneficiary and documented on attendance sheets by half-hour units. We, however, agree that the benefit allows for a once in a lifetime core of training. We provide clarification in Sec. 410.141(c).



SUMMARY: This final rule implements section 4105 of the Balanced Budget Act of 1997 (BBA) by expanding Medicare coverage for outpatient diabetes self-management training and establishes outcome measurements for evaluating the improvement of the health status of Medicare beneficiaries with diabetes. These services include education and training furnished to a beneficiary with diabetes by an approved entity deemed to meet certain quality standards established in this final rule. The physician (or qualified nonphysician practitioner) treating the beneficiary's diabetes must certify that these services are needed as part of the beneficiary's comprehensive plan of care.

EFFECTIVE DATE: These regulations are effective February 27, 2001.

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