Library: Policy

317:30-5-1083. Coverage by category

Revised 09-12-22

The purpose of DSMES services must be to provide the member with the knowledge, skill, and ability necessary for diabetes self-care.

(1) Adults.  Payment is made for medically necessary DSMES provided by eligible providers described in OAC 317:30-5-1081. Refer to OAC 317:30-5-1082 for units of DSMES training allowed.

(2) Children/adolescents.  Payment is made for medically necessary DSMES for members under twenty-one (21) years of age provided by eligible providers described in OAC 317:30-5-1081.  DSMES coverage for children is the same as for adults. Additional DSMES services may be covered under EPSDT provisions if determined to be medically necessary.