How Do You Refer to a Diabetes Education Program?
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To refer a patient to a diabetes education program, a physician must complete a form that includes specific information that allows Medicare or managed care organizations to cover the cost. Because of positive changes to the Medicare DSMT regulations that went into effect in June 2004, the only eligibility criterion is that the person must have type 1, type 2, or gestational diabetes, according to the ADA’s diagnostic definition. Documentation of the diagnosis must be in the person’s medical record, with responsibility for this documentation resting with the referring provider. The person must be referred for DSMT by the treating physician or other qualified nonphysician practitioner (as defined by Medicare), such as a nurse practitioner. An original written referral that “certifies” that the training is needed must be provided. Most recognized programs have referral forms readily available that include the required elements. In addition, a universal referral form for DSMT and MNT is being piloted. The intent is to make the referral more standardized and less cumbersome.
