MLN Matters® Number: MM6510
Related Change Request (CR) #: 6510
Related CR Release Date: August 7, 2009
Effective Date: March 30, 2009
Related CR Transmittal #: R109CP
Implementation Date: September 8, 2009
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Palmetto GBA for DSMT services provided to Medicare beneficiaries.
Impact on Providers
This article is based on Change Request (CR) 6510 which recognizes the American Association of Diabetes Educators (AADE) as an approved Diabetes Self-Management Training (DSMT) national accreditation organization. CR 6510 also implements the following exception for DSMT in rural areas: an individual who is qualified as a registered dietitian and as a certified diabetic educator who is currently certified by an organization approved by the Centers for Medicare & Medicaid Services (CMS) may furnish training and is deemed to meet the multidisciplinary team requirement.
Background
The Centers for Medicare & Medicaid Services (CMS) announced in their Final Notice published in the Federal Register (Volume 74, February 27, 2009) that the American Association of Diabetes Educators (AADE) is approved as a national accreditation organization to furnish DSMT and is recognized as a national accrediting organization for accrediting entities to furnish outpatient DSMT to Medicare beneficiaries. See the Federal Register (V74, February 27, 2009) at http://edocket.access.gpo.gov/2009/pdf/E9-3287.pdf (PDF, 56 KB).
Providers and suppliers of DSMT services may submit requests for accreditation through the AADE, and Medicare contractors shall recognize the AADE as an approving entity for the DSMT program billable through Medicare.
In addition, if providers/suppliers had a valid AADE certificate disapproved by their Medicare contractor, they may ask their contractor to reprocess that application.
CR 6510 also amended the Medicare Benefit Policy Manual (Chapter 15 (Covered Medical and Other Health Services)) to clarify that there is an exception for who can provide DSMT in a rural area as follows:
“…Registered dietitians are eligible to bill on behalf of an entire DSMT program on or after January 1, 2002, as long as the provider has obtained a Medicare provider number. A dietitian may not be the sole provider of the DSMT service. There is an exception for rural areas. In a rural area, an individual who is qualified as a registered dietitian and as a certified diabetic educator who is currently certified by an organization approved by CMS may furnish training and is deemed to meet the multidisciplinary team requirement.”
See the Code of Federal Regulations (CFR), Title 42, Chapter IV, Section 410.144(a)(4)(C)(ii) which describes the exception for DSMT in rural areas at http://edocket.access.gpo.gov/cfr_2008/octqtr/pdf/42cfr410.144.pdf (PDF, 55 KB).
Additional Information
The official instruction, CR 6510, issued to Palmetto GBA regarding this change may be viewed at
www.cms.hhs.gov/Transmittals/downloads/R109BP.pdf (PDF, 112 KB).
If you have any questions, please contact our Provider Contact Center at our toll-free number (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.