I. Background:

A. Information And Statistics About Diabetes

Diabetes mellitus is a disease of metabolism presenting as a complex group of syndromes that have in common elevated blood glucose levels. It occurs because the insulin produced by the beta cells of the pancreas is either absent, insufficient, or not used properly by target tissues. As a result, the body is unable to metabolize macronutrients in food in the normal way. Since the body cannot convert glucose into energy, high levels of glucose remain in the blood and spill into the urine, eventually resulting in micro-vascular complications (for example, kidney disease and eye disease) and macro-vascular complications (for example, stroke and ischemic heart disease).

There are two major types of diabetes that affect the Medicare population, Type 1 diabetes, previously called insulin dependent diabetes mellitus, and Type 2 diabetes, previously called non-insulin dependent diabetes mellitus.

The goals in the management of diabetes are to achieve normal metabolic control and reduce the risk of micro and macro-vascular complications. Numerous epidemiologic and interventional studies point to the necessity of maintaining good glycemic control to reduce the risk of the complications of diabetes.

Despite this knowledge, diabetes remains the leading cause of blindness, lower extremity amputations, and kidney disease requiring dialysis. Diabetes and its complications are primary or secondary factors in an estimated 9 percent of hospitalizations (Aubert, RE, et al., Diabetes-related hospitalizations and hospital utilization. In: Diabetes in America. 2nd ed. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease, NIH, Pub. No. 9514681995: 553570).

Overall, beneficiaries with diabetes are hospitalized 1.5 times more often than beneficiaries without diabetes. Ten percent of these hospitalizations are a direct result of uncontrolled diabetes, and more than half of these admissions occur in beneficiaries 65 and older (National Hospital Discharge Survey, U.S. National Center for Health Statistics, U.S. Department of Health and Human Services, 1990). In expanding the Medicare program to include outpatient diabetes self-management training services, the Congress intended to empower Medicare beneficiaries with diabetes to better manage and control their conditions. The Conference Report indicates that the conferees believed that this provision will provide significant Medicare savings over time due to reduced hospitalizations and complications arising from diabetes. (H.R. Conf. Rep. No. 105217, at 701 (1997)).

According to the National Health and Nutrition Examination Survey (NHANES):

(Diabetes Fact Sheet, The Centers for Disease Control & Prevention https://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf)

According to the Department of Health and Human Services Centers for Disease Control and Prevention (CDC):

B. Statutory Authority for Diabetic Self-Management Training (DSMT)

Section 4105(a) of the Balanced Budget Act of 1997 (BBA) (pub. L. 105-33), enacted on August 5, 1997, provides for Medicare coverage for DSMT services provided by a certified provider. Section 4105 of the BBA amended section 1861 of the Social Security Act (The Act) by adding a new section (q)(q).

Section 1861(qq) of the Social Security Act (the Act) provides CMS with the statutory authority to regulate Medicare outpatient coverage of DSMT services.

Section 1861(q)(q)(2) provides that the Secretary may recognize a physician, individual, or entity that is recognized by an organization as meeting standards for furnishing these services as a certified DSMT provider. This statute also provides that a physician or other individual or entity shall be deemed to have met such standards if they meet applicable standards originally established by the National Diabetes Advisory Board.

Section 1861(q)(q)(2)(B) of the Act states that a physician, or such other individual or entity, meets the quality standards if the physician, or individual or entity, meets quality standards established by the Secretary, except that the physician or other individual or entity shall be deemed to have met such standards if the physician or other individual or entity meets applicable standards originally established by the National Diabetes Advisory Board and subsequently revised by organizations who participated in the establishment of standards by such Board, or is recognized by an organization that represents individuals (including individuals under this title) with diabetes as meeting standards for furnishing the services.''

Additionally, section 4105(c)(1) of the BBA requires the Secretary to establish outcome measurements for purposes of evaluating the improvement of the health status of Medicare beneficiaries with diabetes.

A final rule (65 FR 83130) was published in the Federal Register on December 29, 2000 which implemented the BBA provisions addressing the coverage, payment, quality standards, and accreditation requirements for DSMT. This final rule also implemented the DSMT regulations which are codified at Title 42 of the Code of Federal Regulation (CFR) sections 410.140 to 410.146.

The CMS regulations at 42 CFR 410.144 provide the authority for the CMS to require the DSMT AOs to use one of the following types of accreditation standards: (1) the accreditation standards set forth at 410.144(a); (2) the accreditation standards issued by the National Standards for Diabetes Self-Management Education Support (NSDSMES) (410.144(b)); or (3) other accreditation standards, so long as they have been submitted to CMS and approved as meeting or exceeding the CMS quality standards described at 410.144(a).

The American Diabetes Association (ADA) and the American Association of Diabetic Educators (AADE) are the two national DSMT AOs approved by CMS to accredit entities that furnish DSMT services. These DSMT AOs are approved by CMS for six-year terms. Section 410.143(a) sets forth the ongoing responsibilities of the DSMT AOs. The requirement at section 410.143(b) sets forth the oversight activities that CMS, or its agent, will perform to ensure that a CMS approved DSMT AO and the entities the organization accredits continue to meet a set of quality standards described at 410.144.

Section 410.145 of the regulations specifies requirements that DSMT entities must meet. Section 410.146 requires that approved entity must collect and record in an organized systematic manner, patient assessment information at least on a quarterly basis for a beneficiary who receives DSMT training.

II. Information about the Diabetic Self-Management Training Accrediting Organizations

A. General Information

B. Information About The ADA Education Recognition Program (ERP)

C. Information About the AADE

III. Contact Information for CMS-designated DSMT Accrediting Organizations

There are two accrediting organizations approved by CMS to accredit DSMT entities. The contact information for these DSMT AO is listed below.

American Diabetes Association (ADA)

2451 Crystal City Drive

Suite 800

Arlington, VA 22202

703-549-1500

Phone: 800-342-2383

Website: http://www.diabetes.org

American Association of Diabetic Educators (AADE)

200 W. Madison

Suite 800

Chicago, IL 60606

Phone: 800-338-3633

Website: https://www.diabeteseducator.org

IV. Oversight and Validation Process for DSMT Accrediting Organizations Accreditation Processes

V. Where to Submit Questions Related to the DSMT Accreditation Program

Questions about the DSMT Accreditation Program may be submitted to the DSMT Accreditation email box at DSMTAccreditation@cms.hhs.gov.

We monitor this email box on a frequent basis and will respond to your email as soon as possible.

Read more here:
Diabetic Self-Management Training (DSMT) Accreditation Program