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Diabetes Self Management Training Initiative
Purpose of the Program
There is an increasingly critical need to provide Diabetes Self-Management Training (DSMT) to older adults. On a national level, almost 25% of adults over age 60 have diabetes.i Seventeen percent of diabetes cases are newly diagnosed in individuals age 65 and older.ii Although this number is alarming, the real impact of diabetes can be seen when you look at the complications related to poor management of the disease state. Diabetes is the leading cause of kidney failure, lower-limb amputations, and new cases of blindness among US adults.iii The financial impact of diabetes is significant. Medical expenditures for persons with diabetes are 2.3 times higher than what it would be for a person without the disease.iv Many of the complications related to poor self-management of diabetes could be reduced by helping persons with diabetes better manage their disease. The result would be an improvement in health outcomes, better quality of life, and reduced disease complications. To meet the increasing demand for supporting older adults with diabetes, AoA is working with the American Diabetes Association (ADA) and the American Association of Diabetes Educators (AADE) to build upon the existing 3200 accredited community-based DMST sites around the country.
The U.S. Administration on Aging is working with the ADA, AADE, Stanford University’s Patient Education Research Center, the National Council on Aging (NCOA), and philanthropic organizations to implement accredited diabetes self-management education programs in selected community-based settings in an effort to provide outreach, education, and treatment to older adults who have been diagnosed with diabetes. While improving participants’ control of blood glucose levels and reducing the incidence of disease complications related to diabetes, the program also has the potential to reduce the overall cost of treating persons with diabetes. This model of diabetes self-management education uses the Stanford University Diabetes Self-Management Program as a part of the curriculum but also requires the delivery of additional wrap around services to each participant.
Under Medicare Part B, a prevention benefit is offered that helps older adults with diabetes manage their condition better. The benefit covers the cost of diabetes self-management training for persons with a diagnosis of diabetes. However, the DSMT benefit under Medicare is underutilized-- in 2004 and 2005, about 1% of Medicare beneficiaries who had been diagnosed with diabetes utilized the diabetes self-management training (DSMT) benefit.v Potential reasons for the lack of use of this Medicare benefit may be limited awareness of the benefit, and limited access to the services. Currently most DSMT programs are provided in clinical settings such as hospitals. Availability of community-based diabetes self-management programs may improve both access and awareness of this benefit.
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Benefit History
In 2002, the Centers for Medicare & Medicaid Services (CMS) began providing reimbursement for DSMT services. The benefit provides reimbursement for up to ten (10) hours of DSMT within a twelve (12) month period. All recognized Medicare providers can submit for reimbursement when services are provided to an eligible beneficiary with a diagnosis of diabetes. The Medicare benefit allows for 80% of the cost of the service with a 20% required co-insurance/co-payment. In order to be reimbursed for DSMT services, an eligible Medicare provider must first obtain accreditation from either ADA or AADE, then submit a request to CMS to be a recognized DSMT provider. After these two steps are complete, the Medicare provider can then begin submitting claims for DSMT services to be reimbursed by CMS.
Community-based, peer-led diabetes self-management programs enable seniors who are Medicare beneficiaries to access their prevention benefits within a community location. These programs positively affect the lives of many older adults who would normally lack access to such programs, or may feel uncomfortable participating in programs that take place within clinical environments. By increasing access to DSMT programs, many seniors will learn and adopt essential diabetes self-management techniques.
Medicare covers a total of ten hours of DSMT services that include one (1) hour of individual training and nine (9) hours of group training. After the initial training year, Medicare will cover up to two (2) hours of follow-up training in each subsequent year. Lastly, Federally Qualified Health Centers (FQHCs) are approved to provide DSMT services and are reimbursed by Medicare for the service (applicable to CMS-approved FQHC billing guidelines).
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AoA Funding History
AoA began supporting the Diabetes Self Management Training Initiative, using the Stanford University Diabetes Self-Management Program as a part of the curriculum, to help build a workforce of trainers for diabetes education courses for seniors over age 60. In 2008, AoA provided $200,000 in training support to states, and continued that support by providing approximately $340,000 in funding in 2009. Since 2010, AoA has been giving the sites technical assistance toward development of their programs. In addition, AoA is working with the DSMT sites to develop a toolkit to capture best practices and to aid others in the Aging Network who are interested in establishing community-based peer-led DSMT programs.
In 2010, the U.S. Administration on Aging began providing direct technical assistance to select sites that have been providing DSMP programs in their community. The goal of the technical assistance was to assist Area Agencies on Aging sites and their partners with structuring their program to meet the accreditation standards of either ADA or AADE. Each site must identify a Medicare provider partner that will work with them to deliver the DSMT classes. Once they have secured a provider partner, they must structure their program so that it can meet the National Standards for Diabetes Self-Management Education, while ensuring that they maintain fidelity to their Stanford DSMP programs.vi Once their DSMP programs are administered in accordance with the National Standards, they can apply to receive accreditation and then submit to CMS to be a recognized DSMT provider.
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Resources and Useful Links
For more information about the Diabetes Self Management Training Program, visit the Stanford University School of Medicine
For more information on the American Association of Diabetes Educators, visit http://www.diabeteseducator.org/
For more information on the American Diabetes Association, visit http://www.diabetes.org/
For more information on the preventive benefits offered under Medicare Part B, visit http://www.cms.gov/PrevntionGenInfo/
i Centers for Disease Control and Prevention. Number of People with Diabetes Increases to 24 Million (Press Release 2008) Available at: http://www.cdc.gov/media/pressrel/2008/r080624.htm
ii Centers for Disease Control and Prevention. Distribution of Age at Diagnosis of Diabetes Among Adult Incident Cases Aged 18–79 Years, United States, 2008. Available at http://www.cdc.gov/diabetes/statistics/age/fig1.htm
iii Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and pre-diabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
iv American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2007. Diabetes Care: 31,3 (2008). URL: http://care.diabetesjournals.org/content/31/3/596.abstract
v American Association of Diabetes Educators, Diabetes Education Fact Sheet. Available at: http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/Diabetes_Education_Fact_Sheet_2009.pdf
vi Diabetes Care January 2008 vol. 31 no. Supplement 1 S97-S104
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| Last Modified: 9/14/2011 8:05:41 AM |
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