Revision 23-1, Effective Nov. 13, 2023 

Overview

Diabetes self-management education services are used to:

• assess the person’s ability to independently manage his or her diabetes at home;
• assess the person’s ability to independently manage his or her diabetes in the workplace;
• prepare a person to make informed choices about his or her diabetes; and
• help the person develop the confidence and skills to implement his or her choices.

Qualifications

Diabetes self-management education services are provided by a vendor who instructs and counsels the individual and family through individual and/or group skills training.

Education and Experience Requirement

A vendor is a health professional, who:

• is licensed or registered, as required by his or her profession;
• has completed basic academic requirements for his or her field;
• has practiced for at least one year; and
• has one year of diabetes education experience.

A vendor must be a registered nurse (RN), registered dietician (RD), or certified diabetes educator (CDE). For RNs and RDs, the service provider keeps a copy of the active license on file. For a CDE, the service provider keeps a copy of the current certification from the National Certification Board for Diabetes Education (NCBDE) or the American Association of Diabetes Educators (AADE) on file.

Through academic preparation, continuing education, or on-the-job training, the vendor will have developed:

• a knowledge and understanding of diabetes and its management, including the nutritional and pharmaceutical aspects of care;
• a knowledge and understanding of basic educational and behavioral science;
• a knowledge of evidence-based nutritional, pharmaceutical, and therapeutic care of the person with diabetes;
• the additional skills necessary to work in a thorough and efficient manner, such as planning, organizing, communicating, cooperating, delegating, and working without direct supervision; and
• a knowledge of visual impairment and blindness.

A vendor (CDE, RN or RD) must have at least one year of paid experience providing diabetes education. RNs and RDs must have completed 15 hours of continuing education units (CEUs) on diabetes from an accredited agency within the 12 months immediately preceding the application date. A CDE must have completed 10 hours of CEUs on diabetes from an accredited agency within the 12 months immediately preceding the application date. The CEUs must be from an agency approved by the service provider's licensing or certifying body.

A diabetes vendor is determined to be qualified if the vendor holds a contract in good standing with the Texas Workforce Commission’s vocational rehabilitation program.

The service provider must verify the education and experience requirements and make that verification available to HHSC at any time and in any format requested.

Training Requirement

The vendor must attend required training as developed that may include training about visual impairment or blindness.

If travel is necessary in order to attend the required training, the vendor is responsible for paying all travel costs including transportation, food, and lodging.

Technical Skills Requirement

A vendor must:

• be able to assess a person’s educational needs and clinical status;
• have public speaking skills;
• offer interactive teaching techniques for people;
• be able to communicate technical medical information at a level appropriate for the learner;
• be able to create a positive and accepting learning environment;
• be able to relate positively to all people;
• believe in the capabilities and independence of people with disabilities;
• have good verbal and written communication skills;
• have basic computer skills, including word processing; and
• have a private email address, which will not be given to non-approved staff members.

The potential vendor must be able to demonstrate knowledge about diabetes and behavioral change as well as demonstrate skill in the use of the adaptive techniques that are available to people who are blind or visually impaired.

Scope of Services

Up to 15 hours of individual diabetes self-management education services are considered standard. The 15 hours include the initial assessment, skills training, and post training assessment.

Diabetes self-management education services include:

• an initial assessment that is generally up to two hours;
• skills training on diabetes self-management that is generally up to 12 hours; and
• a post training assessment which is generally up to one hour.

Individual skills training on diabetes self-management is divided into short, two-hour blocks segments, to reduce travel costs and ensure that the person maintains the physical and intellectual stamina needed to benefit from the skills training.

Reimbursement

HHSC only reimburses providers for its vendor’s time spent teaching people about diabetes.

Vendors are not reimbursed for:

• travel time;
• planning time;
• office interaction time; or
• time spent completing and submitting the required paperwork.

Assessing Diabetes Self-Management Education Services

The vendor ensures that the individualized education plan, which includes the initial assessment, instructional and skills training methods and teaching materials, is appropriate for each person, based on the person’s:

• age;
• type of diabetes (type I or II) and duration;
• cultural influences; and
• learning abilities.

The initial assessment for each person must include their: 

• relevant medical history;
• cultural influences;
• health beliefs and attitudes;
• diabetes knowledge;
• self-management skills and behaviors;
• readiness to learn;
• cognitive ability;
• physical limitations;
• level of family support;
• financial status;
• employment issues related to diabetes, if any; and
• current or potential need for adapted diabetes devices, including talking monitors for blood sugar or blood pressure, syringe magnifiers, and count-a-dose aids.

As part of the initial assessment, the vendor recommends the specific skills training that the person may need.

The training may include information on:

• the pathophysiology of diabetes (an overview);
• nutrition;
• exercise and activity;
• blood glucose monitoring and use of the monitoring results;
• diabetes-related complications;
• management of sick days;
• medical treatment;
• medication;
• foot, skin, and dental care;
• preconception care, pregnancy, and gestational diabetes;
• insulin;
• use of the health care system;
• community resources;
• stress and psychosocial adjustment;
• goal setting;
• employment issues or barriers to employment, as related to diabetes; and
• adaptive diabetes self-management equipment and tools.

If an initial assessment was conducted within the last 12 months and there has been no significant change in the person’s medical status such as no new medications prescribed, no new complications reported, and the vendor believes that there is adequate information to begin skills training, then training may begin immediately based on that evaluation.

If it has been more than 12 months since the previous assessment, or if there has been a significant change in the person’s medical status, another initial assessment must be conducted to evaluate the person’s current medical status and educational needs.

Training and Assessment Tool Kit

It is highly recommended that the service provider have a tool kit of adaptive equipment to demonstrate during assessment and training.

The items suggested for the tool kit are as follows:

• Blood glucose meter
• Count-a-dose
• Magniguide
• Meal Measure
• Insulin pen or other injectable for demonstration purposes
• Talking blood pressure monitor

It is also recommended that the disposable supplies needed to demonstrate the adaptive equipment such as test strips, syringes and insulin, be made a part of the training tool kit.

Skills Training for Diabetes Self-Management

The number of skills training hours recommended for individual diabetes self-management is based on:

• the initial assessment; and
• the topics covered that are related to the person’s independent living goals.

Skills training on diabetes self-management must include:

• goals for behavioral change; and
• participation in healthy lifestyle changes.

A copy of the current diabetes education materials is provided to the person in their preferred medium such as large print and CD.

Other education materials, resources, and referrals are documented on the required forms.

Diabetes self-management education is primarily intended to:

• provide knowledge and skills training; and
• help the person identify barriers, solve problems, and develop coping skills to achieve effective self-care and behavior change.

The initial assessment and subsequent skills training on diabetes self-management is based on the seven self-care behaviors identified by the American Association of Diabetes Educators (AADE).

The AADE’s seven self-care behaviors known as AADE7 are:

• healthy eating;
• being active;
• monitoring;
• taking medications;
• healthy coping;
• problem solving; and
• reducing risk.

Confidentiality of Information

To protect the integrity and dignity of each person, the service provider must keep their information confidential, as required by the Health Insurance Portability and Accountability Act (HIPAA), as applicable. The service provider must have policy and procedures in place that facilitate access to confidential records.

The vendor must develop and use physical safeguards for confidential records and ensure that the records are available to authorized staff members only.

Post-Training Assessment

Post-training follow-up assessments are conducted by the vendor at least one month or 30 calendar days after the skills training is completed.

As part of the post-training assessment, the vendor:

1. reviews the skills training provided; and
2. reinforces the behavioral changes.

If a post-training assessment is provided before one month or 30 calendar days after the skills training is completed, the vendor must secure approval from the referring service provider.

Documentation

The service provider's initial assessment, skills training, equipment follow-up assessment, and other findings for each person are documented using forms developed and provided by the service provider.

Exceptions

When speaking by phone or in person to the independent living service provider about differences in service delivery, including changes in a service authorization or no-show request, the service provider's call or in-person discussion should be documented in an email between all parties.