Utah Admin. Code R414-90-5 - Service Coverage

(1) Patient assessment for the DSMT program shall include:

(a) a review of medical history;

(b) risk factors;

(c) health status;

(d) resource utilization;

(e) knowledge and skill level; and

(f) cultural barriers to effective diabetes self-management.

(2) DSMT is limited to a maximum of ten sessions of outpatient services as ordered by a physician.

(3) DSMT is limited to training presented by a qualified provider within an accredited or recognized program that meets the standards of the National Diabetes Advisory Board covering seven ADA and ADCES self-care core curriculum content areas. The program must also be accredited by the ADA or recognized by the ADCES.

(4) DSMT shall allow for direct, face -to -face interaction between the educator and the member.

(5) Diabetes self-management training must be sufficient in length to meet the goals of the member's basic comprehensive plan of care. Individual sessions must be sufficient in number and designed to meet the individual's cultural and learning needs.

(6) A member who repeats any part of a DSMT program may only be treated for new conditions that arise or changes in health status.

(7) Medicaid also covers the following DSMT services:

(a) annual eye examination that includes dilation;

(b) annual physical;

(c) glycosylated hemoglobin laboratory test with foot examination;

(d) blood sugar review; and

(e) blood pressure reading every three to four months.

(8) Medicaid does not cover charges for facility use.

Notes

Utah Admin. Code R414-90-5

Amended by Utah State Bulletin Number 2024-07, effective 3/25/2024