Licensure for Diabetes Educators FAQs

WHY IS AADE SUPPORTING THE EFFORT TO GAIN LICENSES FOR THOSE THAT ARE PRACTICING DIABETES EDUCATION?

AADE is constantly working towards gaining increased recognition and reimbursement for our members, the professionals who deliver diabetes education. Over the years, this effort has been challenging because there is no legal scope of practice for diabetes educators like there is for other healthcare professions.

State licensure is the first step towards legal recognition for the diabetes educator. Even though most diabetes educators have additional education, training and sometimes certification in diabetes management, it is largely a self-identified specialization.

State licensure will give the diabetes educator a legal scope of practice, and it offers patients a measure of protection by ensuring that the diabetes education they receive is provided by a qualified professional with adequate training to meet a standard level of diabetes care.

We anticipate that as licensure for diabetes educators becomes more widespread, the profession will gain recognition and more healthcare professionals will choose to enter the field—thereby growing the profession and helping to meet the needs of the increasing numbers of individuals with diabetes.

WHY DIABETES EDUCATOR LICENSURE?

Professional licensure has numerous purposes: consumer protection, professional recognition and setting quality guidelines for the profession.

Management of diabetes is complex. It is very important that the health care professionals who set themselves out as diabetes educators be well educated and appropriately credentialed in the delivery of quality diabetes education.

Licensure of the diabetes educator will provide a scope of practice and minimum provider qualifications.

Diabetes educators Licensure is intended for the health care professional who has a defined role as a diabetes educator, not for those who may perform some diabetes related functions as part of or in the course of other routine occupational duties.

All health care providers need sufficient diabetes knowledge to provide safe, competent care to persons with or at risk for diabetes. Licensure of the diabetes educator will provide minimum standards for patient safety and for recognition of the professional. This will address the current workforce shortage of qualified professionals who can deliver diabetes education. Read more on the afffect of the Affordable Care Act on diabetes education.

DOES LICENSURE HELP DIABETES EDUCATORS WITH GETTING REIMBURSED FOR THEIR SERVICES?

Medicare and some private payers may reimburse for diabetes education services, but they may not recognize (reimburse) the provider of these services – the professionally qualified diabetes educator. State licensure would further open the door for the recognition of and payment to the professional diabetes educator for their services as similarly licensed health care professionals are recognized and paid for their services.

DOES LICENSURE UNDERMINE THE CERTIFIED DIABETES EDUCATOR (CDE) or BOARD CERTIFIED - ADVANCED CLINICAL DIABETES MANAGEMENT (BC-ADM) CREDENTIAL?

Currently, any licensed healthcare professional (or unlicensed individual) can practice diabetes education. A credential (such as the CDE or BC-ADM)  IS NOT  required for the practice of diabetes education.

Even though healthcare professionals have to be licensed in their respective fields to be eligible to sit for a credential, professional licensure boards (such as those for RNs and LDs) have no jurisdiction over the practice of diabetes education or the diabetes educator.

Licensure would set the minimum quality standards and the scope of practice for the diabetes educator. It ensures that all healthcare providers who deliver diabetes education will have sufficient knowledge to provide safe, effective care to persons with or at risk for diabetes.

Licensure and credentials ARE NOT mutually exclusive. Certification is a non-statutory process whereby an accrediting body grants recognition to an individual for having met predetermined professional qualifications.

The CDE and BC-ADM are a voluntary credentials. The NCBDE is an independent credentialing body. It has no enforcement capabilities over the quality of diabetes education or the individuals who deliver diabetes education. The NCBDE does not take consumer complaints nor does it investigate or sanction the individuals they for which they grant certification.

State licensure for the diabetes educator definitely DOES NOT UNDERMINE THE CDE or BC-ADM , but rather encourages growth in the profession by opening up employment opportunities which provides the practice hours needed to qualify for the credentials.

WHO WILL BE ELIGIBLE TO BE A LICENSED DIABETES EDUCATOR? WHAT ARE THE QUALIFICATIONS?

AADE believes that Diabetes Self-Management Training (DSMT) is a crucial element in the health care of people with diabetes. DSMT is shown to reduce health care costs and deliver health benefits to patients. State licensure sets the quality standards and scope of practice for diabetes educators who wish to provide DSMT. While AADE does not have power over licensure standards, we advocate that state regulatory licensing boards consider the following recommendations:

Discipline

  • Healthcare professional disciplines include, but are not limited to: registered nurses, registered dietitians, registered pharmacists, licensed mental health professionals, and exercise physiologists.

Education

  • A bachelor's degree or education that meets the state's healthcare professional licensure requirements for the primary discipline. Completion of AADE's Core Concepts Course or a diabetes education program sponsored by any advanced academic or continuing education organization that meets state-determined standards and provides a minimum of 15 hours of learning in the biological and social sciences, communication, counseling, and education.
  • 15 hours of continuing education related to diabetes self-management education and training each year.

Professional Practice Experience

  • 250 hours within a two-year time frame, specific to diabetes self-management education and training; evidence of experience caring for people with diabetes.

HOW WILL LICENSURE IMPROVE ACCESS TO DIABETES EDUCATION?

Diabetes is a growing public health epidemic affecting more than 25 million Americans, and according to the American Diabetes Association, 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older each year.

The Center for Disease Control estimates that approximately 79 million American adults have pre-diabetes 27% of  American are living with diabetes and don’t know it.

There are approximately 17,000 CDEs and BC-ADMs combined.

Any way you do the math, there are not enough CDEs and BC-ADMs to go around.

There are many others who identify themselves as diabetes educators and work in the field, but are not eligible or choose not to pursue a credential. We must find a way to recognize these individuals and ensure that others who are delivering diabetes education are properly prepared, trained and qualified. State licensure is the way to do this.

Because the number of individuals with diabetes is increasing, more healthcare professionals are needed to help patients learn to manage the disease and prevent further health complications. Licensure for diabetes educators can help grow the specialty into a standardized, more recognized profession and could encourage more healthcare professionals to enter the field.

A more qualified diabetes educator means better patient care and outcomes.

HOW DOES THIS AFFECT OUR NATIONAL EFFORT TO GAIN MEDICARE PROVIDER STATUS FOR CREDENTIALED DIABETES EDUCATORS?

It is the effort to gain Medicare recognition of the credentialed diabetes educator that generated the state licensure initiative. A barrier to gaining provider status for the diabetes educator is that there is no legal definition (scope of practice) for the profession. Other healthcare professionals have licensure or registration requirements and a professional scope of practice.

While we will continue to pursue Medicare recognition using the CDE and BC-ADM credentials, state licensure will improve our chances of succeeding in that effort.

WILL STATE LICENSURE OF DIABETES EDUCATORS AFFECT THE REQUIREMENTS FOR AADE OR ADA PROGRAM ACCREDITATION?

Program accreditation is a separate process that relates to Medicare reimbursement for services. It is not affected by state licensure.

WHO IS A DIABETES EDUCATOR?

Diabetes educators are healthcare professionals who focus on educating/training people with and at risk for diabetes and related conditions achieve behavior change goals which, in turn, lead to better clinical outcomes and improved health status. Diabetes educators apply in-depth knowledge and skills in the biological and social sciences, communication, counseling, and education to provide self-management education/self-management training.

WHAT IS DIABETES SELF-MANAGEMENT TRAINING/EDUCATION (DSMT/E)?

Diabetes education, also known as diabetes self-management training (DSMT) or diabetes self-management education (DSME), is a collaborative process through which people with or at risk for diabetes gain the knowledge and skills needed to modify behavior and successfully self-manage the disease and its related conditions. DSMT/E is an interactive, ongoing process involving the person with diabetes (or the caregiver or family) and a diabetes educator(s). The intervention aims to achieve optimal health status, better quality of life and reduce the need for costly health care.

LICENSE VS. CREDENTIAL (CDE OR BC-ADM) – ARE THEY BOTH NECESSARY?

The license and credential  ARE NOT  mutually exclusive. Certification is a non-statutory process whereby an accrediting body grants recognition to an individual for having met predetermined professional qualifications.

The CDE and BC-ADM are voluntary credentials. The NCBDE is an independent credentialing body. It has no enforcement capabilities over the quality of diabetes education or the individuals who deliver diabetes education. The NCBDE does not take consumer complaints nor does it investigate or sanction the individuals they certify.

Even though healthcare professionals have to be licensed in their respective fields to be eligible to sit for a credential, this would not be redundant as the RN and LD professional licensure boards have no jurisdiction over the practice of diabetes education or the diabetes educator. Licensure would set the minimum quality standards and the scope of practice for the diabetes educator.

Any licensed healthcare professional (or unlicensed individual) can now practice diabetes education. A CDE or BC-ADM  IS NOT required for the practice of diabetes education.

FEDERAL VS STATE LEGISLATION – ARE THEY REDUNDANT?

The legislation currently being considered in the US Congress would have the center for Medicare and Medicaid Services (CMS) recognize the credentialed diabetes educators as a Medicare provider of DSMT. Medicare reimbursement is based on the individual base health care credential. The RD, NP, or other licensed health care professionals can be reimbursed by Medicare. Other than a few state Medicaid programs, CDEs and BC-ADMs are not recognized DSMT providers and  CANNOT get reimbursed with that credential alone.

EVIDENCE-BASED PRACTICE

The National Standards for the delivery of DSMT are the requirements for the accreditation of DSMT programs, not individual diabetes educator qualifications. CDEs are not required under these standards for DSMT programs.

The AADE has developed Practice Guidelines and Provider Competency levels. The Competencies define the diabetes educator and their necessary qualifications. The licensure proposal reflects the Competencies Level 3 as the baseline for the qualified diabetes educator.

The Level 3 diabetes educator competency includes the clinician with several years of experience in the delivery of diabetes education. At this level, though not credentialed the diabetes educator continues to gain knowledge and skill through preparation and practice.