Library: Policy

317:30-5-1082. Scope of services

Revised 9-12-22

(a) General provisions.  The OHCA covers medically necessary DSMES services when all the following criteria are met:

(1) The member has been diagnosed with diabetes by a physician or qualified non-physician provider working within the scope of his/her licensure;

(2) The services have been ordered by a physician or qualified non-physician provider who is actively managing the member's diabetes;

(3) The services are provided by a qualified DSMES provider [Refer to OAC 317:30-5-1081 (a)(2)]; and

(4) The program meets the current ADA or ADCES training standards.

(b) Training. DSMES services shall provide one (1) initial assessment per lifetime. Initial DSMES shall be comprised of up to ten (10) hours [can be performed in any combination of thirty (30) minute increments] of diabetes training within a consecutive twelve (12) month period beginning with the initial training date, including:

(1) One (1) hour of individual instruction, consisting of face-to-face encounters between the diabetes educator and the member; and

(2) Nine (9) hours of group instruction.

(c) Follow-up DSMES. After the first twelve (12) month period has concluded, members shall only be eligible for two (2) hours of individual or group DSMES instruction per calendar year.