NTTAC Resources for DSMES/T

DSMES Accreditation and Recognition Process

The Centers for Medicare & Medicaid Services (CMS) has authorized the Association of Diabetes Care & Education Specialists (ADCES) and the Americans with Disabilities Act (ADA) to grant accreditation (ADCES) or recognition (ADA).

Both ADCES and ADA have a formal application process, require supporting documentation, and require a fee with applications. ADCES and ADA also require annual reports and renewals and audit existing programs to ensure continued conformance with accreditation or recognition criteria. Each program is identified by its acronym: “DEAP” for Diabetes Education Accreditation Program (ADCES) and “ERP” for Education Recognition Program (ADA).

Being an accredited or recognized service benefits DSMES providers in many ways, including:

The ability to bill for DSMT (see note below) through Medicare, some state Medicaid agencies, and many private insurers.
Improved care and health status reporting.
Alignment with quality improvement and population health goals.
Access to ADCES or ADA resources and support.

Note: CMS uses the term “training” (DSMT) instead of “education and support” (DSMES) when defining the reimbursable benefit. This term relates specifically to Medicare billing

Diabetes education programs are developed to serve the diabetes community by offering quality education that meets a set of standards and is then eligible for third-party insurance reimbursement. Determine whether diabetes education programs meet required standards.

Why DSMES?

There are not enough DSME programs available to meet the needs of the increasing number of people with diabetes.

Diabetes self-management education (DSME) continues to be cited as a cornerstone of effective diabetes care and a crucial part of a patient's success in living well with diabetes.

An educational standards framework such as the National Standards for Diabetes Self-Management Education (NSDSME) plays an important role in standardizing the educational process, content, and outcome measurement for helping people with diabetes or at risk for diabetes enhance their quality of life and better manage their condition.

Because of the increased incidence of diabetes and increased demand for DSME, diabetes education programs are needed in a variety of settings beyond hospital outpatient and doctors' office settings

Such additional settings include pharmacies and community centers. However, nontraditional settings still must be held accountable for quality, reliability, and accuracy.

Accreditation/Recognition supports the provision of quality DSME, is essential for reimbursement, and offers public acknowledgment of accomplishment.

Diabetes Self-Management Training (DSMT) Accreditation Program

The American Diabetes Association® (ADA) and the Association of Diabetes Care & Education Specialists (ADCES) 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.

he ADA and ADCES use the accreditation standards established by the NSDSMES. These standards have been approved by CMS as meeting or exceeding the standards set forth at 42 CFR 410.144.

The NSDSMES quality standards are reviewed and revised approximately every five years by a task force of key stakeholders and experts within the diabetes care and education community. The current version of the NSDSMES standards was released in February 2022. These standards are scheduled for review again in 2027.

All entities that provide DSMES that are operating under the current NSDSMES are eligible to apply for ADA recognition of the DSMES program.

ADCES is an organization dedicated solely to the specialty of diabetes care and education. ADCES has the expertise and resources required to support DSMES programs throughout our organization and specifically within our Diabetes Education Accreditation Program (DEAP) Department. ADCES, through collaboration with other diabetes organizations, jointly revises and embraces the NSDSMES.

The NSDSMES is the framework upon which accreditation is based. ADCES’ interpretive guidance is collaboratively developed with stakeholders and quality coordinators, abides by these standards and is approved by CMS.

ADCES DSMES program accreditation is intended for DSMES services provided in the non-acute care setting.

Both ADCES and ADA have a formal application process, require supporting documentation and a fee with application.
ADCES and ADA also require annual reports and renewals and audit existing programs to ensure continued conformance with accreditation or recognition criteria.

Benefits of Accreditation/ Recognition

Being an accredited or recognized service benefits DSMES providers in many ways, including:

The ability to bill for DSMT (see note below) through Medicare, some state Medicaid agencies, and many private insurers.
Improved care and health status reporting.
Alignment with quality improvement and population health goals.
Access to ADCES or ADA resources and support.

Note: CMS uses the term “training” (DSMT) instead of “education and support” (DSMES) when defining the reimbursable benefit. This term relates specifically to Medicare billing.

Diabetes Self-Management Education and Support (DSMES) Accreditation Guide - PDF

National Standards for DSMES

Accreditation and recognition processes ensure that services offer quality education
Makes the services eligible for reimbursement from Medicare, many private health plans, and some state Medicaid agencies.

Accrediting Organizations

The Centers for Medicare & Medicaid Services (CMS) has authorized the American Diabetes Association (ADA) and the Association of Diabetes Care & Education Specialists (ADCES) to determine whether DSMES services meet required standards
Although ADA uses the term “recognition” and ADCES uses the term “accreditation,”
The two terms involve the same processes.
Both organizations rely on the latest edition of the National Standards for Diabetes Self-Management Education and Support to evaluate DSMES services.

Standard 1: Support for DSMES Services

The DSMES team will seek leadership support for implementation and sustainability of DSMES services. The sponsor organization will recognize and support quality DSMES services as an integral component of diabetes care. Sponsor organizations will provide guidance and support for DSMES services to facilitate alignment with organizational resources and the needs of the community being served.

Standard 2: Population and Service Assessment

The DSMES service will evaluate their chosen target population to determine, develop, and enhance the resources, design, and delivery methods that align with the target populations’ needs and preferences.

Standard 3: DSMES Team

All members of a DSMES team will uphold the National Standards and implement collaborative DSMES services, including evidence-based service design, delivery, evaluation, and continuous quality improvement. At least one team member will be identified as the DSMES quality coordinator and will oversee effective implementation, evaluation, tracking, and reporting of DSMES service outcomes.

Standard 4: Delivery and Design of DSMES Services

DSMES services will utilize a curriculum to guide evidence-based content and delivery, to ensure consistency of teaching concepts, methods, and strategies within the team, and to serve as a resource for the team. DSMES teams will have knowledge of and be responsive to emerging evidence, advances in education strategies, pharmacotherapeutics, technology-enabled treatment, local and online peer support, psychosocial resources, and delivery strategies relevant to the population they serve.

Standard 5: Person-Centered DSMES

Person-centered DSMES is a recurring process over the life span for PWD. Each person’s DSMES plan will be unique and based on the person’s concerns, needs, and priorities collaboratively determined as part of a DSMES assessment. The DSMES team will monitor and communicate the outcomes of the DSMES services to the diabetes care team and/or referring physician/other qualified healthcare professional.

Standard 6: Measuring and Demonstrating Outcomes of DSMES Services

DSMES services will have ongoing continuous quality improvement (CQI) strategies in place that measure the impact of the DSMES services. Systematic evaluation of process and outcome data will be conducted to identify areas for improvement and to guide services optimization and/or redesign.

What IPDC Provides

Support with the application process
Support with application fee (as needed)
Technical Assistance to meet the required standards for accreditation/recognition
Support with the interviewing process for accreditation/ recognition
Technical Assistance with annual reports to maintain accreditation/recognition for continued conformance with accreditation/recognition performance