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DSMT Toolkit

Chapter 9. AADE Accreditation Guidelines

AADE

To seek accreditation from AADE, complete an AADE application and mail it along with the initial application fee. In addition, AADE requires a comprehensive description of the program, which includes the program’s curriculum. Generally, accreditation lasts for a period of three (3) years and reaccreditation lasts for a period of four (4) years. However, AADE has the discretion to modify the accreditation period term.

AADE Fees

The current prices (2012) for accreditation for the initial application and any subsequent reaccreditation are:

  • Programs with up to ten (10) sites providing DSMT services - $800.00
  • Programs with eleven (11)–twenty (20) sites providing DSMT services - $1,200.00
  • Programs with over twenty (20) sites providing services must contact AADE for customized pricing based on the specific number of sites and size of the organization.

Once a site receives accreditation, it can add additional sites—up to 10—without paying an additional fee to AADE.

AADE Application Process

Once AADE receives the application and fee, the average length of time for review is 4-6 weeks. It is important to note that AADE requires that the program be in operation long enough to take at least one participant through to the development of the participant’s follow-up plan at the completion of the course, follow-up prior to submitting for accreditation. The application process requires the submission of supporting documentation about the program and will include a complete review of select patient records to ensure that the program adheres to the National Standards for DSMT. Lastly, the program must have a fully implemented quality improvement program to ensure that high quality services are being monitored to improve healthcare outcomes for individuals participating in the program.

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AADE Instructors

Programs must have a primary qualified instructor. This instructor must be a licensed registered nurse, licensed dietitian, or licensed pharmacist. The person must have a current license to serve in this role. Current status as a certified diabetes educator does not supersede the licensure requirement. To obtain accreditation, a certified diabetes educator (CDE) does not have to be part of the program’s staff. In addition, instructors must have documentation showing that they obtained at least 15 continuing education hours of diabetes-specific training, annually. The program must also have a defined program coordinator. The program coordinator is not required to be a CDE, registered nurse, licensed dietitian, or licensed pharmacist. However, the program coordinator must be a professional that has experience and training in managing chronic disease programs.

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AADE Accreditation

Once the program attains accreditation, it will need to obtain recognition from CMS. After recognition occurs, the program can begin submitting to Medicare for reimbursement.

In addition to the accreditation requirement, the program must have a Medicare provider number to bill for services. DSMT services are billed under the Medicare “G” billing codes. It is important to note that accreditation does not guarantee reimbursement from Medicare. There are additional guidelines for Medicare reimbursement that will affect the process of reimbursement. It is important that the program adhere to Medicare billing guidelines in order to obtain reimbursement for services.

A continuous quality improvement (CQI) process is required to obtain accreditation under AADE guidelines. However, participant health outcomes have no bearing on the program’s ability to obtain initial accreditation or reaccreditation.

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AADE Role of Community Health Workers

Community health workers (CHWs) are an approved part of AADE programs. The CHW is required to play a role that is non-technical and non-clinical. The instruction provided by CHWs is meant to connect professional healthcare services to the community. CHWs can play a key role in identifying potential program participants, as well as providing program support to increase adherence and decrease attrition. CHWs can also play a key role in areas that have diverse populations. In these areas, CHWs are trusted members of the community and have the ability to leverage this trust to encourage community residents who would benefit from the program, to participate. CHWs must obtain ongoing education and guidance from diabetes educators and other healthcare professionals involved in the program. The training of CHWs should be focused on core diabetes concepts.

complete records review is a mandated part of the AADE accreditation process. The records review is conducted to ensure that the care provided meets DSMT standards. An AADE reviewer will review and document whether the information in the record meets AADE standards.

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AADE Documents Required to Submit for Accreditation

The following are required items that must be identified in the records selected for review:

  • Individual assessment
  • Goal-setting
  • Educational plan
  • Implementation plan
  • Evaluation of DSMT effectiveness
  • Compliance with developing personalized follow-up plans for on-going self-management support
  • Compliance with using qualified instructors
  • Physician Communication

When submitting program records for review, it is important to adhere to certain guidelines and to remove all personally identifiable information (PII). The submission of personal information, without the individual’s consent, is a violation of the Health Insurance Portability and Accountability Act (HIPPA).

To comply with HIPAA guidelines, the following information regarding individuals must be removed from submissions that are part of the accreditation review:

  • Name
  • Phone number
  • Address
  • Social Security number
  • Medicare number
  • Medical record number
  • Health plan beneficiary number
  • E-mail address
  • Account number

AADE accreditation application materials can be obtained from the AADE website: http://www.diabeteseducator.org/ProfessionalResources/accred/Application.html.

AADE also requires an annual status report, which can be found at: http://www.diabeteseducator.org/ProfessionalResources/accred/Annual_Status.html

It is important to note that after a DSMT program receives accreditation from AADE and Medicare recognition from the fiscal intermediary, the program may experience a CMS audit after billing begins. CMS performs the audit and coordinates this effort with AADE and/or ADA in selecting sites.

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