Diabetes Self-Management Education and Support, or DSMES, teaches participants how to:
- eat healthy
- be active
- monitor blood sugar levels
- take medication
- problem solve
- reduce risk for other health conditions
- cope with their disease.
It is evidence-based and improves clinical outcomes, health status, and quality of life.
There are two accrediting organizations recognized by the Centers for Medicare and Medicaid Services (CMS). Colorado Medicaid follows the CMS policy of requiring accreditation from one of these programs:
- The American Diabetes Association’s Education Recognition Program (ERP) provides the framework for effective delivery of quality diabetes self-management education and support (DSMES) through the National Standards of DSMES.
- The Association of Diabetes Care and Education Specialists Accreditation Program (DEAP) can help you get diabetes education accreditation, and receive reimbursement for diabetes self-management education and support.
- The American Diabetes Association (ADA) and the Association of Diabetes Care and Education Specialists (ADCES) endorse the 2022 National Standards for Diabetes Self-Management Education and Support to promote quality education for people with diabetes.
Staff Requirements
At least one of the team members responsible for facilitating DSMES services must be ONE of the following:
- Registered Nurse (RN)
- Registered Dietitian/Nutritionist (RD/RDN)
- Pharmacist with training and experience pertinent to DSMES (PharmD)
- Healthcare professional holding certification as a Diabetes Care and Education Specialists (CDCES) or a Board Certification in Advanced Diabetes Management (BC-ADM)
Please note:
- Other members of the healthcare team may contribute to the provision of DSMES services with appropriate training in DSMES and with supervision and support by at least one of the team members listed above.
For more info
For more information on staff requirements and continuing education requirements for your DSMES team see Standard 3 of the 2022 National Standards for DSMES: DSMES Team.
Curriculum
Examples of existing curricula that meet Standard 4 of the 2022 National Standards for DSMES.
Please note: this is not a comprehensive list.
- ADCES Diabetes Education and Care Curriculum (ADCES website)
- ADA Life with Diabetes (American Diabetes Association website)
- International Diabetes Center BASICS Diabetes Curriculum
- Skaggs School of Pharmacy: Virtual Curriculum
- this curriculum was developed from the ADCES curriculum
- Healthy Interactions Diabetes Conversation Map (Healthy Interactions website)
The typical benefit for DSMES is 1 hour of individual and 9 hours of group education within the initial year, and 2 hours of DSMES (individual or group) each year after. (This may vary by private payers).
Colorado Medicaid
- 2022 Colorado Medicaid DSMES Reimbursement Toolkit (PDF)
- Let Colorado Medicaid know of your accreditation/recognition status on the Diabetes Self-Management Education Accreditation Registration webpage to begin billing for your services.
Medicare
- Resources for Medicare Reimbursement (CDC website)
- Medicare Reimbursement Guidelines for DSMT* (CDC website)
- *Note the Centers for Medicare and Medicaid Services (CMS) uses the term “training” (DSMT) instead of “education and support” (DSMES) when defining the reimbursable Medicare billing benefit.
- Additional CMS billing and payment guidelines on the CMS website.
- Novitas Solutions website, Colorado’s Medicare Administrative Contractor (MAC)
Private Payers
- We recommend contacting private payers directly, as coverage varies.
Telehealth
- DSMES services provided via telehealth allow participants to receive the same benefits as in-person visits along with the added convenience of video conferencing, phone calls, or texting to receive the critical care they need.
- See the guides below to learn more about how to implement telehealth services in your organization:
- CDC's Guide to Using Telehealth for DSMES and NDPP (PDF)
- CDPHE Telehealth DSMES/NDPP Implementation Guide (PDF)
Medicare Coverage for Telehealth
- Medicare covers individual and group DSMT* and MNT telehealth sessions when: 1) injection training is not required 2) Medicare beneficiaries reside in rural health professional shortage areas
- *CMS uses the term “training” (DSMT) instead of “education and support” (DSMES) when defining the reimbursable Medicare billing benefit.
- More information on the CMS benefit policy for telehealth can be found beginning on page 147 of the Medicare Claims Processing Manual.
- Note: Due to the COVID-19 Public Health Emergency, Medicare has introduced some temporary flexibilities to telehealth services. Refer to pages 86-89 of the Covid 19 FAQs on Medicare Fee-for-Service (FFS) Billing document:
Medicaid Coverage for Telehealth
- DSMES via telehealth is a Colorado Medicaid covered benefit.
- Non-physician providers are now authorized to provide health education services (the provision of counseling, referral, instruction, suggestions, and support to maintain or improve health) under general supervision of a provider; direct supervision is no longer required as long as the supervising provider is immediately available via audio/visual or audio.
- More information can be found on the Colorado Department of Health Care Policy and Financing webpage.
Medical Nutrition Therapy (MNT)
- MNT is defined as a “nutrition-based treatment provided by a registered dietitian nutritionist” (DSMES Toolkit: MNT).
- The MNT benefit is a completely separate, yet complementary, benefit from Diabetes Self-Management Training (DSMT). MNT can reduce A1C by up to 2%, making it an essential component of initial and ongoing diabetes care.
- Studies have shown that DSMT and MNT are more effective together than either service would be if offered alone.
- Note: Medicare will not reimburse DSMT and MNT if provided on the same day.
Best Practice Resources
- 2023 ADA Standards of Medical Care in Diabetes. (American Diabetes Association website)
- DSMES Consensus Report. (PDF)
- Colorado DSMES Lessons Learned/Best Practices Roadmap. (PDF)
Participant Education Resources
- Patient Education Materials: Cornerstones4Care by NovoNordisk. (NovoMedlink website)
- ADA Patient Education Library. (American Diabetes Association website)
- ADCES Tools and Resources available in English and Spanish. (Association of Diabetes Care & Education Specialists website)
- CDC Diabetes Kickstart Videos English (CDC website)
- Serie en video Diabetes Kickstart (Un buen comienzo) Spanish. (CDC website)
Marketing/Outreach Tools
Marketing and outreach is vital to DSMES sustainability. You can use these tools and resources to help you better engage providers and connect with future participants:
- Healthcare Provider-facing Materials
- DSMES Info Sheet. (PDF)
- DSMES FAQs. (PDF)
- Provider Satisfaction Survey. (PDF)
- Tools for DSMES Educators
- Social Media Campaign Materials
- DSMES Social Media Campaign Materials. (Google Drive Folder)
Join the DSMES monthly sharing calls
Are you in need of additional support? Would you like to connect with other DSMES providers in your state?
Whether your program is brand new or has been around for years, our monthly sharing calls, facilitated by CDPHE, exist to support you.
With low utilization of DSMES services amongst Coloradans affected by diabetes, the primary purpose of the calls is to provide an opportunity for partners to discuss barriers to DSMES utilization, share successes, and identify tools that may be helpful in increasing participation in DSMES services throughout the state.
Subscribe to our DSMES email list and you will receive information and invites to our monthly calls, every third Wednesday of the month.
Nationwide Programs
Colorado Programs
- For more detailed information on local Colorado programs, check out the 2-1-1 Colorado database to find a DSMES provider near you.
While evidence-based programs can decrease the burden of diabetes, in 2017 only 59.4% of Colorado adults with diabetes reported having ever taken a diabetes self-management class.
VISION
- The CDPHE Visual Information System for Identifying Opportunities and Needs (VISION) is a dashboard illustrating chronic disease burden in Colorado.
Diabetes Data & Statistics
- The Centers for Disease Control (CDC) Diabetes Data & Statistics webpage.
State of Diabetes in Colorado
- 2019 Fact Sheet (PDF)
Diabetes Burden in Colorado
- 2019 Presentation (PDF)
DSMES Conference Video
- Diabetes Burden (mp4)
CDPHE
- Chronic Disease Data & Reports (webpage)
- Center for Health and Environmental Data (webpage)
DSMES Conference Videos
- DSMES Conference: Summary Video (mp4)
- Oral Health (mp4)
- Audiology (mp4)
- Design Thinking (mp4)
Refer to DSMES
Share these resources with providers interested in referring to DSMES:
- CDPHE: Refer to DSMES (webpage)
- Sample DSMES/MNT Referral Form (PDF)
For further guidance, contact Lisa Bentley, Diabetes Management Coordinator at CDPHE: lisa.bentley@state.co.us
Additional Contacts:
Association of Diabetes Care and Education Specialists (ADCES): deap@adces.org 800.338.3633
American Diabetes Association (ADA): erp@diabetes.org 1.800.DIABETES (342.2383)
Colorado Medicaid Claims and Billing Questions: 1.844.235.2387