OHCA Policies and Rules
317:30-5-1081. Eligible providers and requirements
[Revised 09-12-22]
(a) In order to receive Medicaid reimbursement for DSMES services, providers or provider groups must:
(1) Be working under an accredited DSMES program that meets the quality standards of one (1) of the following accreditation organizations:
(A) The ADA; or
(B) The ADCES.
(2) Be fully contracted with SoonerCare as a "diabetes educator". Eligible DSMES providers include:
(A) A registered dietician (RD) who is:
(i) Licensed and in good standing in the state in which s/he practices.
(ii) Has training and experience pertinent to diabetes self-management education and support verified by the OHCA Pharmacy Services unit.
(B) A registered nurse (RN) who is:
(i) Licensed and in good standing in the state in which s/he practices.
(ii) Has training and experience pertinent to diabetes self-management education and support verified by the OHCA Pharmacy Services unit.
(C) A pharmacist who is:
(i) Licensed and in good standing in the state in which s/he practices.
(ii) Has training and experience pertinent to diabetes self-management education and support verified by the OHCA Pharmacy Services unit.
(D) A health care provider, as defined in Section 3090.2 of Title 63 of the Oklahoma Statutes, who holds a certification as a:
(i) CDCES; or
(ii) BC-ADM.
(b) All DSMES programs must adhere to the national standards for diabetes self-management education.
(1) Each DSMES program must include at least one (1) of the eligible providers listed above in OAC 317:30-5-1081 (a) (2) (A) B (D).
(2) All members of the instructional team must complete the nationally recommended annual continuing education hours for diabetes management.
Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.
