DBS Standards Manual for Consumer Services Contract ProvidersChapter 5: Services

Effective September 1, 2015

5.9 Diabetes Self-Management – Education Services

5.9.1 Job Function

DBS educates consumers about diabetes self-management.

The purposes of dDiabetes self-management education services are used to:

  • assess the consumer’s ability to independently manage the disease at home;
  • assess the consumer’s ability to independently manage the disease in the workplace;
  • assess the consumer’s ability to participate in intensive blind rehabilitation training for persons who are blind, such as the training sessions and mini-training sessions offered by DARS such as Criss Cole Rehabilitation Center (CCRC)training or minitrainings;
  • prepare a DBS consumer to make informed choices about his or her diabetes; and
  • help the consumer develop the confidence and skills to implement his or her choices.

The comprehensive program covers a full range of issues from nutrition to stress management. A diabetes educator instructs and counsels the consumer and family through individual and group training.

5.9.2 Qualifications

Diabetes self-management education services are provided by a service provider who instructs and counsels the consumer and family through individual and/or group skills training.

Education, Training, and Experience Requirement

A diabetes educatorservice provider is a health professional, who:

  • is licensed or registered, as required by his or her profession;,who
  • has completed basic academic requirements for his or her field; and
  • has practiced for at least one year.

A service provider for consumers must be a registered nurse (RN), registered dietician (RD), or certified diabetes educator (CDE). For RNs and RDs, DARS Contract Oversight and Support (COS) unit keeps a copy of the service provider's active license on file. For a CDE, COS keeps a copy of the service provider's current certification from the National Certification Board for Diabetes Education (NCBDE) or the American Association of Diabetes Educators (AADE) on file.

Through academic preparation, continuing education, or on-the-job training, the diabetes educator orservice provider will have developed:

  • a knowledge and understanding of diabetes and its management, including the nutritional and pharmaceutical aspects of care;
  • a knowledge and understanding of basic educational and behavioral science; and
  • the additional skills necessary to complete required work in a thorough and efficient manner, such as planning, organizing, communicating, cooperating, delegating, and working without direct supervision; and
  • a knowledge of the Texas Confidence BuildersPphilosophy.

Diabetes self-management education services for DBS consumers are provided by a registered nurse (RN), registered dietician (RD), or certified diabetes educator (CDE). For RNs and RDs, a copy of the provider's current license must be on file. For a CDE, a copy of the provider's current certification from the National Certification Board for Diabetes Education (NCBDE) or the American Association of Diabetes Educators (AADE) must be on file.

A The diabetes educator orservice provider (CDE, RN, or RD) must have at least one year of paid experience providing diabetes educationworking with people who have diabetes and must have experience working in group settings. RNs and RDs must have completed 15 hours of continuing education units (CEUs) on diabetes from an accredited agency within the last 12 months of the application date. A CDE must have completed 10 ten hours of CEUs on diabetes from an accredited agency within the last 12 months of the application date. The CEUs must be from an agency approved by the service provider’s licensing or certifying body.

The service provider must send a copy documenting the CEUs to the diabetes field program specialist (DPFS).,who maintains

The specialist:

  • retains a copy in the specialist’s DFS file; and
  • forwards a copy to the regional program support specialist (RPSS).
Technical Skills Requirement

A service providerThe diabetes educator or instructor must have:

  • be able to assess a consumer’s assessment techniques for both educational needs and clinical status;
  • offer group instruction and public speaking skills;
  • offer interactive teaching techniques for individuals and groups;
  • be able the ability to communicate technical medical information at a level appropriate for the learner;
  • be able the ability to create and communicate a positive and accepting learning environment;
  • be able the ability to relate positively to all consumers;
  • believe a belief in the capabilities and independence of people with disabilities;
  • have good verbal and written communication skills;
  • have basic computer skills, including word processing; and
  • have a private email address, which will not be given to non-approved staff members.

To determine a potential service provider’s knowledge about diabetes and behavioral change, a diabetes program specialist may interview the potential provider during the initial contracting process and/or ask him or her to take a skills test. A skills test and an interview with the diabetes field specialist may be conducted during the initial contracting process to gather information about a potential provider’s diabetes and behavioral change expertise.

Required Training Requirement

Before providing services to DBS consumers, the diabetes educator orservice provider must either:

  • attenda Texas Confidence Builders training session conducted by the DBS diabetes field program specialist; or
  • attend an approved mini-training session,followed by and the next available Texas Confidence Builders training.

Veteran diabetes educatorsservice providers must attend Texas Confidence Builders training at least every two years.

The Texas Conference Builder trainingis a 14-hour training led by the diabetes field program specialist., whichThe training includes a two-hour blindfold experience. The diabetes educator orservice provider is expected to attend the entire training. Exceptions must be approved by the diabetes program specialist DFS in writing before the training begins.

At the discretion of the DBS diabetes field program specialist, diabetes self-management education service providers may also be required to attend additional periodic training seminars.

If travel is necessary in order to attend the required training, the service provider is responsible for paying all travel costs including transportation, food, and lodging.

5.9.3 Service Provider Authorization and Reimbursement

Diabetes self-management education sServices must not begin untilDBS has issued a service authorization and/or purchase ordera service authorization (SA) has been issued by DARS. It is the service provider’s responsibility to check the accuracy of the PO SA before scheduling a the visit with the consumer.

If the service provider is unable to schedule the visit within a fewthree calendar weeks, the service provider notifies should notify the consumer’s vocational rehabilitation counselor (VRC) or independent living worker (ILW).

Service Pproviders must have written authorization from DBS before the service provider or the provider's employees providesdiabetes self-management education services to DBS consumers. DARS does not pay for diabetes self-management education services,No service will be paid if the servicesare is provided before DBS written authorization is received.

For additional information, please see Chapter 1: Basic Standards, 1.6.4 Additional Requirements/Documenting Staff Changesof this manual and Chapter 4: Service Delivery Guidelines, 4.2 Staff Information Sheets.

Group Training

Diabetes service providers are encouraged to coordinate group training (two or more consumers at a time). Group trainings are cost efficient and should be used when they will benefit the instruction process and better meet the needs of the consumer. Approval must be obtained from the referring case manager before training begins. The initial assessment and posttraining assessment should be done individually so that health information and concerns may be addressed privately.

Diabetes education providers are reimbursed only for time spent teaching consumers about diabetes and not for travel time, planning time, office interaction time, or time spent completing and submitting the required paperwork.

Blood Glucose Meter

For the purpose of evaluating and training DBS consumers, diabetes self-management education service providers may use the nontalking and talking blood glucose meter currently recommended by DBS. If another talking meter is recommended, the diabetes field specialist must approve it before training.

If the talking blood glucose meter recommended by DBS is changed, the provider has 90 days following DBS notification of change to obtain a new talking blood glucose meter.

5.9.4 5.9.3 Service Delivery

Scope of Services

Up to 15 hours of can be approved for individual and group diabetes self-management education services can be approved, including skills training. Additional hours must be approved by the field director and discussed with the DFSdiabetes program specialist (DPS).

Self-management of diabetes is an important component of antreatment education plan. The management education plan must should be customized for each consumer’sconsidering

  • age;,
  • schedule;,
  • level of physical activity;,
  • eating patterns;,
  • cultural factors;,
  • personality;, and
  • diabetes-related any presence of complications of diabetes or other medical conditions (ADA, 2003e).

Diabetes self-management education services include:

  • an initial assessment (up to two hours);,
  • skills training on diabetes self-management education (up to 12 hours); and
  • a post training assessment (up to one hour).

Individual skills training on diabetes self-management training is divided into short should be broken into reasonable segments (ideally, two-hour blocks) to reduce control travel costs and ensure that the consumer maintains the physical and intellectual stamina needed to benefit from the skills training.

Group sessions (that is, sessions for two or more consumers at a time) can be cost effective. Service providers are encouraged to coordinate group skills training sessions when they will benefit the instruction process and better meet the needs of the consumer. Approval must be obtained from the referring case manager before skills training begins.

If group skills training sessions are conducted, the initial assessment and post training assessment must be conducted individually, so that a consumer’s health information and other concerns may be addressed privately.

Providers of diabetes education are reimbursed only for the time spent teaching consumers about diabetes.

Providers are not reimbursed for:

  • travel time;
  • planning time;
  • office interaction time; or
  • time spent completing and submitting the required paperwork.

Note: If diabetes self-management education sServices may take more or less than the recommended amount of time (for instance, if an assessment may takes more than two hours),.But the service provider: must document the any exceptions to the recommended amount of time; and include the documentation in the report before DBS DARS will consider payment.

The Rrequired documentation must be submitted within 35 calendar days of the training date that any diabetes self-management education service is provided, including initial assessment, skills training, and post training assessment).

Service providers Providers are strongly encouraged to call or email the consumer’s vocational rehabilitation counselor (VRC) or independent living worker (ILW) immediately when situations arise that affect the consumer’s health or ability to participate in training skills training on diabetes self-management.

Assessing Diabetes Self-Management Education Service

The service provider ensures that the individualized education plan (including the initial assessment, instructional and skills training methods, and teaching materials) is appropriate for each consumer, based on the consumer's:

  • age;
  • type of diabetes (type I or II) and duration;
  • cultural influences; and
  • learning abilities.
The Initial Assessment

The initial assessment for each DBS consumer must include the consumer’s:

  • relevant medical history;,
  • cultural influences;,
  • health beliefs and attitudes;,
  • diabetes knowledge;,
  • self-management skills and behaviors;,
  • readiness to learn;,
  • cognitive ability;,
  • physical limitations;,
  • level of family support;,
  • financial status;,and
  • any employment issues related toaspects of diabetes.

As part of the initial assessment, the service provider recommends the specific skills training that the consumer may need.

The training may include information on:

  • the pathophysiology of diabetes (an overview);
  • nutrition;
  • exercise and activity;
  • blood glucose monitoring and use of monitoring results;
  • diabetes-related complications;
  • management of sick days;
  • medical treatment;
  • medication;
  • foot, skin, and dental care;
  • preconception care, pregnancy, and gestational diabetes;
  • insulin;
  • use of the health care system;
  • community resources;
  • stress and psychosocial adjustment;
  • goal setting; and
  • employment aspects and/or barriers related to diabetes.
Blood Glucose Meter

For the purpose of assessing consumers and providing them with skills training, service providers may use the talking blood glucose meter recommended by DBS. If the provider recommends using another talking meter, the diabetes program specialist must approve it before skills training occurs.

If DBS changes its recommendation on a talking blood glucose meter, the service provider has 90 calendar days after being notified about the change to obtain the new talking blood glucose meter.

The consumer’s vocational rehabilitation counselor (VCR) or independent living worker (ILW) is responsible for approving the purchase of the recommended equipment or supplies.

Skills Training for Diabetes Self-Management

The number of skills training hours recommended for individual diabetes self-management is based on:

  • the initial assessment; and
  • the topics covered that are related to the consumer’s vocational and independent living goals.

Skills training on diabetes self-management must include:

  • goals for behavioral change; and
  • participation in healthy lifestyle changes.

A copy of the current DARS diabetes education materials is provided to the consumer in his or her preferred medium (for example, large print, CD, and so on).

Other education materials, resources and referrals are documented on the required forms.

Diabetes self-management education is primarily intended to:

  • provide knowledge and skills training; and
  • help the consumer identify barriers, solve problems, and develop coping skills to achieve effective self-care and behavior change.

The initial assessment and subsequent skills training on diabetes self-management is based on the seven self-care behaviors identified by the American Association of Diabetes Educators.

The AADE’s seven self-care behaviors (known as AADE7) are:

  • healthy eating;
  • being active;
  • monitoring;
  • taking medications;
  • healthy coping;
  • problem solving; and
  • reducing risk.

Group Training

Skills training for diabetes self-management can be provided:

  • in a group of two or more consumers; or
  • as a combination of one-on-one and group training sessions.

In most cases, the training should not exceed 15 hours, total.

Individual skills training for diabetes self-management may be authorized, if group training cannot be scheduled in a timely manner.

The initial assessment and subsequent skills training are usually conducted in the consumer's home. If the skills training is conducted in a group and meets outside the consumer's home, the training and payment are different. Contact the DARS regional program support specialist (RPSS) for more information.

Post-Training Assessment

Post- training (follow-up) assessments are conducted by the service provider at least one month (30 calendar days) after the skills training is completed.

As part of the post training assessment, the service provider:

  • reviews the skills training provided; and
  • reinforces the behavioral changes.

If a post-training assessment is provided before one month (30 calendar days) after the skills training is completed, the service provider must secure approval from the referring case manager.

5.9.5 Documentation of AssessmentDiabetes Self-Management Education Services

Documentation of Initial Assessments

The service provider's initial assessment and other findings for each DBS consumer is are documented using:

  • DARS2888, Diabetes Self-Management Education Assessment;,and,
  • DARS2901, Diabetes Pre- and Post-assessment.

If a talking blood pressure monitor is recommended, the service provider must provide the consumer a DARS2305, Certificate of Medical Necessity: Physician Order for Blood Pressure Monitor. The consumer is responsible for completing the form, including obtaining the physician’s signature, and returning it to his or her VRC or ILW.

For consumers who have third-party payors, the diabetes educator and referring staff member work together to identify local resources to get equipment and supplies for the consumer using his or her benefits (see Similar Benefit Reimbursement below for additional information).

The VRC or ILW is responsible for approving the purchase of the recommended equipment or supplies.

Diabetes Self-Management Education Program Content

Diabetes self-management skills training can be provided to a consumer in a group consisting of two or more DBS consumers, or to a consumer in a combination of one-on-one and group meetings not to exceed 15 hours. Individual self-management skills training may be authorized if group training cannot be scheduled in a timely manner.

The initial assessment and subsequent teaching are usually done in the consumer's home. However, if the training is provided in a group and meets outside the consumer's home, the training and payment are different. Contact DBS for more information.

The number of individual training hours should be based on the assessment and cover topics related to the consumer’s vocational and independent living goals. Training should include behavioral change goals and participation in healthy lifestyle changes.

The service provider ensures that the individualized training plan, instructional methods, and teaching materials are appropriate for each DBS consumer based on the consumer's age, type and duration of diabetes, cultural influences, and learning abilities. A copy of the current DARS diabetes education materials should be provided to the consumer in his or her preferred medium (large print, CD, etc.). Other resources and referrals are documented on the required forms.