1. Why should I consider AADE DEAP?
As the only organization dedicated solely to diabetes education, AADE has the expertise and resources required to support DSMT programs. DEAP includes program flexibility, multi-site accreditation, a simple fee structure and a stop-start online application with the ability to upload your supporting documents. DEAP not only supports sites in traditional settings, but has significantly expanded program options for diabetes care professionals by offering improved support for community-based settings such as physician offices, pharmacies, churches, and community centers.
2. How do I know if my program is eligible?
A Diabetes Self-Management Education/Training (DSME/T) program is eligible for accreditation if it provides “out-patient” services that has fully implemented the National Standards (National Standards for DSME). Your program must be up and running and you must have taken at least one patient through the program.
3. Once my program is accredited, will it be eligible for reimbursement?
Accreditation is required for Medicare reimbursement of the G codes for DSMT. Accreditation does not, however, guarantee reimbursement. Although most payers require that a DSME/T program has accreditation, reimbursement criteria vary. For example, Medicare provides reimbursement for accredited DSMT programs that are considered "Certified Providers." Many private payers require that provider agreements be in place prior to providing reimbursement. AADE has some guides and products on reimbursement information:
- Navigating the Maze is a resource guide on reimbursement
- "Ask the Reimbursement Expert" in our Member Center is an excellent source open to AADE members
- Our free Physician Tips Booklet
- Adding a site and wondering about Reimbursement? Check out our site consideration guidance.
DSMT Reimbursement Tips:
- Sponsoring organization must have an NPI number as well as be enrolled as a Medicare provider
for services other than DSMT
- NPI application forms: https://nppes.cms.hhs.gov or for paper application, call 800-465-3203.
- If new to Medicare, need to submit Form 855I to enroll as a Medicare provider (obtain forms through local Medicare Administrative Contractor (MAC))
- DME/Pharmacy providers must also enroll as a Part B provider to bill for DSMT services
- Must submit notice of AADE accreditation to local Medicare Administrative Contractor (MAC)
- Confirm that the HCPCS codes for billing DSMT are loaded in billing system (G0108 and G0109)
- Submit accreditation notice to contracted commercial payers and verify that DSMT codes G0108 and G0109 are included in contract.
- If off-site locations are added to accredited program, follow process and recommended steps included on AADE website.
- Consider purchasing reimbursement resources such as AADE’s “Navigating the Maze: Overcoming the Obstacles to Reimbursement for Diabetes Self-management”
- Members of AADE can seek additional information from the AADE “Reimbursement Expert” located in our Member Center. Please review the FAQs first because your question may have already been answered.
The best source for reimbursement information is your Medicare Administrator Contractor.
4. How do I get started and how long does it take to complete and process the application?
Once we receive your program fee, application and all of the supporting documentation, the average length of time is 2-6 weeks. AADE will work with you throughout the process to ensure that all the documentation needed has been sent. Samples of supporting documentation are also supplied on our website. You can begin by visiting Applying for Accreditation.
5. Are there any criteria for recently developed or new programs such as a minimum number of participants served and/or a minimum length of time that the program has been providing services?
You will need to be operation long enough for the completion of a review of participant records (at least one patient through to follow up based on your policy) that are representative of your target population. Documentation of the complete diabetes education process is also needed.
6. Are outcomes data required upon application?
No. The National Standards require programs to collect, track and analyze data in order to evaluate their programs and implement a Continuous Quality Improvement (CQI) process. At the time of initial application, the requirement is to have a written CQI plan for process and outcomes evaluation. Once accredited, programs will be required to report information about individual and aggregate outcomes, particularly behavior change goals, on an annual basis. (See the Compliance Enforcement policy.)
7. Who should be the program coordinator?
The program coordinator should be a professional who has experience or educational training in chronic disease and program management. The coordinator can also provide instruction and the job description should reflect the percent of time spent in each function.
8. Do I have to have a CDE involved in the program?
No, but at least one of the instructors needs to be a registered nurse, dietitian, or pharmacist. The instructors must have recent educational and experiential preparation in diabetes education and/or a CDE. All instructors (including a CDE) will have documentation of at least 15 continuing education hours yearly specified as being diabetes-specific, diabetes-related, and behavior change self-management education strategies (e.g., AADE7 Self-Care Behaviors).
9. What is the accreditation fee and how do I submit payment?
If paying by credit card, please call 1-800-338-3633, extension 4861.
10. How can I submit the required supporting documents?
Attn: DEAP200 W Madison St, Ste 800Chicago, IL 60606
11. Does AADE have software I can use to track the data required for DSME/T program accreditation?
Yes, we offer the AADE7 System to help programs to track and report their patient's behavior change and clinical indicators. The AADE7 System is not a requirement for AADE application or accreditation, but can be found at the following link: AADE7 TM System.
12. Must I use AADE's Diabetes Education Curriculum for my accredited program?
No, but the diabetes education curriculum must incorporate the AADE7 Self-Care Behaviors Framework into the educational process. CMS requires DSMT programs to have a written curriculum that includes specified content areas relating to the patient's understanding of self-management skills, knowledge and behavior change.
13. Does the Advisory Group need to meet prior to applying for accreditation?
No, but the Advisory Group composition, plan, and function must be documented.
14. Do I need both AADE accreditation and ADA recognition?
No. You only need one in order to receive reimbursement.
15. What are some of the next steps after my program has received AADE accreditation?
- You will receive a Certificate of Accreditation and a Complaints Poster to be displayed at each program site
- An email will be sent including the AADE DEAP logo and use policy along with other important information
- Your accredited program and contact information will be listed on the AADE DEAP website
- You will need to inform AADE of any status change; for example, new staff, site location, or target population change within 30 days of the change
- You will need to ensure your program is prepared to submit the Annual Status Report and meet the performance measurement and CQI requirements
- Continue to maintain the 10 National Standards for DSMT Programs.
16. What is a "de-identified" chart?
Any information in the medical record that may be linked to an individual must be removed before submitting your de-identified chart with your application materials. The privacy standards that are part of the Health Insurance Portability and Accountability Act (HIPPA) require protection of "individually identifiable" health information. Removing any unique identifying number, characteristics, or codes from the participant chart you submit protects you from any HIPPA violation. Examples of the type of information that must be removed are:
- Geographic subdivision smaller than a state (street address, city, precinct, zip code)
- Telephone or fax numbers
- Social Security number
- Medical record number
- Health plan beneficiary number
- Account number
17. Why is it necessary to submit a patient chart and what parts do I need to include?
Reviewing documentation about the care that was actually provided is a significant part of the accreditation review process and it is used for most accreditation and/or certification processes.
In order to complete a comprehensive review of a diabetes self-management education/training program, it is necessary to review the documentation that provides evidence that the program's Diabetes Education Process was provided in compliance with National DSMT Standards 7 and 8, (and the accompanying DEAP Essential Elements) as well as in accordance with your Diabetes Education Process policy.
The Diabetes Educational Process is comprised of the following (see "Interpretive Guidance" in the "National Standards, Essential Elements and Interpretive Guidance" document on the DEAP website):
- An individualized assessment
- Goal setting
- An educational plan
- Implementation of the plan
- Evaluation of the effectiveness of the DSME/T interventions
Review of an actual patient record will also provide information about:
- Compliance with Standard 8, developing a personalized follow up plan for on-going self-management support,
- Compliance with Standard 5 (provision of DSME/T by qualified instructors).
Review the checklist for the patient chart here.
18. How do I "de-identify" the patient's information?
Using black permanent marker is usually sufficient to effectively hide any data that identifies the patient/participant. Some people have found that using a combination of blue and black markers does a better job of concealing. You could also use "White-Out" or a strip of correction tape.
If you have an electronic health record and are submitting materials electronically, you could delete the necessary information after you have saved it to the format for e-mailing.
19. How do I submit the patient record if I use an electronic health record?
Follow these steps in order to submit an electronic health record
- Obtain a "screen shot" of the components of the record needed
- Save the components identified above in a format that can be e-mailed
- De-identify the screen shot version of the electronic health record
- Save the de-identified version to be sent to AADE DEAP
- Fax, mail, upload into the AADE7 online application or e-mail as an attachement to email@example.com
If the electronic health record does not include the actual assessment questions, (e.g., only the "answers"), submit a template of the assessment form so the reviewer can determine that the assessment process included the necessary elements (see the "Essential Elements" for Standard 7 in the "National Standards, Essential Elements and Interpretive Guidance" document on the DEAP website).
20. What other things does the reviewer look for when reviewing the patient record?
A reviewer will look for some of the following:
- Is there evidence that the education plan was collaboratively developed between the participant and the instructor?
- Are the educational goal/s identifiable?
- Is the plan for educational content identified?
- Is the plan tailored to meet any unique needs of the individual participant?
- Were education services provided according to the plan?
- Is there evidence that the education plan was revised if necessary?
- Can you tell who provided what services?
- Was achievement of the learning objectives identified?
- Is there evidence that a follow-up assessment occured?
- Was a personalized follow-up plan for on-going self-management support developed in collaboration with the participant?
21. How can Community Health Workers (CHWs) be utilized in my program?
Community Health Workers can be an important resource for your program. CMS requires that within accredited diabetes education programs, they are limited to non-technical and non-clinical instructional responsibilities. They will need to receive on-going informal training and formal training as appropriate. CHWs have the unique ability to serve as a bridge between the community and healthcare services because of their position in the community. Please read AADE's position statement for more information on CHWs.
22. Is Telehealth covered in DSME/T?
Please see our updated Telehealth Policy.
23. Is there anything I need to consider before adding an additional site to my program?
24. What do I need a Change of Status form for and when do I need to submit it to AADE?
Adding or removing site(s)
Change in Program Coordinator
Change in Contact information
Change in sponsorship
Program Name Change - additional fees may apply
Change in Target Population
Addition or change in instructional staff
Other significant program changes including change in program name, new organizational structure, closing or suspension of the program, etc.
AADE encourages programs to reach out into the community and provide Diabetes Education. Over the past few years, we have found that many programs attempt to bill from their Community Sites and have been denied by Medicare because the proper notification and documentation was not available. In order to decrease this confusion, we have no defined sites. There are two types of sites: Community Sites and Branch Locations.
26. Definition of a Community Site?
For DSME programs that wish to expand accessibility to their communities.
Community Sites offer the same program as the main location and are simply an extended copy of the accredited diabetes education program. An accredited entity may have up to 10 regularly visited Community Sites at one time. All billing for these services goes through the main location. These sites are not posted on the website and will not receive a separate certificate.
- No cost
- Copy of the same program with minor alterations for specific target population needs
- Up to 10 regularly visited sites
- Same state
- No certificate needed for site
- No individual location website posting
27. What is a Branch Location?
For DSME programs that wish to establish another educational location that would operate semi-independently from the primary program base location.
These locations must be establishments within the same healthcare system entity. They fall under the original program's oversight structure and are required to follow all accreditation guidelines established by AADE and the program.
Branches must be in the same state as the main location, have the same program coordinator, and have the same advisory group. All communications between AADE DEAP for the branches and program as a whole will go through the program coordinator. It is the responsiblity of the program coordinator to distribute information as needed.
Because of their semi-independent nature, these locations have the potential to be audited even if the main location is not chosen. Branch locations get a customized certificate and can bill separately. Certificates will be generated with the ID number and name of the main diabetes education program, but programs can also add an additional qualifier to allow for separate billing. All of the branches will be listed on the AADE website. Each branch location requires an additional $100.00 fee for processing and administrative oversight. Branch locations cannot be from a different business entity umbrella.
- $100.00 fee per location
- Extension of the same program, but run semi-independently and altered for specific target population
- Maximum of 30 locations
- All locations must be in the same state
- Certificate with a custom addendum if indicated
- Website posting
- Same program coordinator
- All Change of Status Reports and other communications are submitted by the program coordinator
- Can have different staff
- Can have different target population
- May be audited
28. What if I am a large organization or corporation?
Due to necessary regulatory and oversight provisions, corporate and commercial entities wishing to seek accreditation for multiple locations need to contact AADE for further discussion and pricing.