New York Medicaid Reimbursement of DSME/T Services

Submission Date: December 2013

State/Territory Submitted on the Behalf of: New York

States/Territories Involved: New York

Domain Addressed:

Community-Clinical Linkages

Public Health Issue:

Diabetes self-management education/training (DSME/T) is an essential part of medical care for diabetes because it is associated with improved diabetes knowledge, self-care behaviors, quality of life, and clinical outcomes such as lower hemoglobin A1C, a measure of average glucose control.

A portion of the patient population served by Medicaid may not receive the benefits of DSME/T due to limited financial resources to pay for programs.

Program Action:

The New York Diabetes Prevention and Control Program (DPCP) convened a task force in partnership with Medicaid to educate state legislators on the potential benefits of enhancing Medicaid’s reimbursement policy for diabetes self-management education/training (DSME/T).

The state legislature adopted a change in reimbursement policy that allowed CDEs to be reimbursed by Medicaid for the delivery of diabetes education and later expanded reimbursement benefits to all certified diabetes education programs.

The DPCP partners with the Office of Health Insurance Program and the Medicaid office to promote the availability of reimbursement and created a CDE electronic mailing list to promote regular communication. They also distribute educational materials to providers about available DSME/T programs and to Medicaid providers to encourage them to refer patients to available programs.

Impact/Accomplishments:

New York now offers better access to DSME/T for people with diabetes enrolled in Medicaid, a population group at higher than average risk of diabetes and its complications that may have had limited ability to pay for this essential service.

Improving access to diabetes education helps satisfy an unmet need identified in parts of New York State through a market analysis of Certified Diabetes Educators conducted by the New York Diabetes Prevention and Control Program in collaboration with NYS Health Foundation’s Diabetes Campaign and SUNY’s Center for Health Workforce Studies.

Medicaid reimbursement for education services is a successful result for New York in the area of 2 of the core diabetes interventions for state programs – increasing access to sustainable self-management education with greatest diabetes burden and risk and advocating for the implementation of policies that promote financial sustain­ability/reimbursement for DSME/T such as Medicaid reimbursement.

Program Areas:

Diabetes

State Contact Information:

New York
Susan L. Millstein, LCSW, MPH
New York State Department of Health
518-408-5142
slm11@health.ny.gov

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