Setting the Standard

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The Health Care Financing Administration (HCFA) has yet to issue a final ruling on its standards for Medicare reimbursement. For many, however, the writing on the wall is clear: to qualify, it’s the ADA’s way or the highway.

Although HCFA provides for up to five deeming entities to certify education programs for Medicare reimbursement, so far only the ADA has applied, and the other four slots remain empty. So, what do exactly do these guidelines entail? Setting a viable national standard is no mean feat, and the ADA has spent almost two years revising and polishing their certification guidelines.

Here are the ten standards all programs must meet if they wish to receive ADA certification, paraphrased from their appearance in the May 2000 issue of Diabetes Care:

  1. The diabetes self-management education (DSME) entity must have a documented organizational structure, mission statement and goals. It must also recognize and support DSME as an integral component of diabetes care.
  2. The DSME entity must determine a target population, then assess the educational needs and resources needed to meet the DSME needs for that target population.
  3. The DSME entity must have an annual planning and review process in which an established system (committee, governing board, advisors, etc.) made up of staff and other stakeholders will examine data and outcome measurements and address community concerns.
  4. The DSME entity must have a designated coordinator with experience in managing programs and caring for individuals with chronic diseases. This coordinator’s role is, in essence, to oversee all aspects of running the DSME entity and make sure that care is dispensed through a coordinated and systematic process.
  5. All individuals with diabetes attending the DSME entity must have access to a multifaceted educational team. Although the team can draw from a number of fields, it must consist of at least one registered dietitian and a registered nurse. All instructional staff must be certified diabetes educators (CDEs) or have recent experience in education and diabetes management.
  6. All of the entity’s instructors must obtain regular continuing education in the areas of diabetes management, behavioral interventions, teaching and learning skills, and counseling skills.
  7. The DSME entity must be able to instruct individuals with diabetes in any of ten content areas. The ten areas include, among others:: describing the diabetes disease process and treatment options; incorporating physical activity into a lifestyle; monitoring blood glucose and, when necessary, urine ketones and using the results to improve control.
  8. DSME instructors must meet with each program participant to come up with an individualized assessment of and management plan for the individual in question.
  9. Each individual’s assessment, education plan, intervention, evaluation and follow-up must be documented and kept in a permanent confidential report.
  10. The DSME entity must constantly evaluate the effectiveness of its education experience and look for opportunities for improvement.

Additionally, qualifying for ADA recognition costs a base fee of $850, with additional fees for additional branches and other incidentals.

The standards were devised by an ADA task force, but other organizations, among them the AADE, were represented as well.

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