2.4.0.0 Re­im­burse­ment

Medi­care re­im­burs­es DSMES when that ser­vice meets the na­tion­al stan­dards (1,4) and is rec­og­nized by the Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) or other ap­proval bod­ies. DSMES is also cov­ered by most health in­sur­ance plans. On­go­ing sup­port has been shown to be in­stru­men­tal for im­prov­ing out­comes when it is im­ple­mented after the com­ple­tion of ed­u­ca­tion ser­vices. DSMES is fre­quent­ly re­im­bursed when per­formed in per­son. How­ev­er, al­though DSMES can also be pro­vided via phone calls and tele­health, these re­mote ver­sions may not al­ways be re­im­bursed. Changes in re­im­burse­ment poli­cies that in­crease DSMES ac­cess and uti­liza­tion will re­sult in a pos­i­tive im­pact to beneficia­ries’ clin­i­cal out­comes, qual­i­ty of life, health care uti­liza­tion, and costs (47).