The Medicare Part B Diabetes Self-Management Training (DSMT) benefit helps eligible beneficiaries learn to manage their diabetes. The training may include education on variety of factors related to the management of diabetes, including healthy eating, blood sugar monitoring, physical activity, medication management, and risk reduction. The initial benefit covers up to 10 hours of initial DSMT: one hour of individual training and nine hours of group. Two hours of follow-up training may be provided during each calendar year subsequent to the initial training. To receive Medicare reimbursement, organizations providing DSMT must be accredited by the Association of Diabetes Care & Education Specialists (ADCES) or the American Diabetes Association (ADA). The National Standards for Diabetes Self-Management Education and Support (DSMES) define ten standards for quality DSMES services that must be met for a program to become nationally accredited or recognized.

The Diabetes Self-Management Program

The Diabetes Self-Management Program (DSMP), from the Self-Management Resource Center, can be used as the core curriculum for DSMES when the following enhancements are added to meet the National Standards for DSMES required for accreditation/recognition by ADCES or ADA:

• An individual assessment and education plan is developed for each participant by the qualified clinician;
• A personalized follow-up plan is developed jointly by the clinician and each participant for ongoing self-management support;
• A registered nurse (RN), registered dietitian (RD), or registered pharmacist (RPh/PharmD) who meets the required continuing education requirements provides overall direction and oversight for the group workshop sessions but does not need to be present in the building while the workshop is conducted;
• An advisory group is established to promote quality; and
• A quality improvement process is in place.

Who Is Eligible for DSMT?

Individuals with type 1 or type 2 diabetes are eligible to receive DSMT services. There must be a written order from the treating physician or a qualified non-physician practitioner who is managing the beneficiary’s diabetes care.

Community-Based Organizations Are Key to Increasing Access to DSMT

According to CDC’s National Diabetes Statistics Report, 2020, diabetes affects 34.2 million U.S. adults. Twenty-six percent of older adults have diabetes, which can compromise quality of life and lead to other serious health conditions, such as glaucoma and kidney disease. While Medicare offers the DSMT benefit to help address this critical public health issue, research shows that only 5% of Medicare beneficiaries receive the benefit. One of the Healthy People 2030 goals is to increase the proportion of older adults who receive diabetes self-management education. Area Agencies on Aging and other community-based organizations can play an integral role in expanding the use of diabetes self-management education via the Medicare DSMT benefit to help achieve this goal.

Toolkits and Guides

• Diabetes Self-Management Training (DSMT) Information Resource: This resource was developed to help community-based organizations plan, implement, and sustain an accredited diabetes self-management education and support (DSMES) program based on reimbursement for the diabetes self-management training (DSMT) benefit.
• Delmarva DSMT Toolkit: This toolkit for Quality Improvement Organizations (QIOs), Federally Qualified Health Centers (FQHCs), healthcare professionals and other key stakeholders explains implementation and reimbursement for accredited DSMT programs that meet CMS requirements for Medicare reimbursement. 
• IHS DSMT Toolkit: This toolkit guides Indian Health Service (IHS) staff in obtaining Medicare reimbursement for Diabetes Self-Management Training (DSMT) services. It outlines seven steps that range from becoming a Medicare-recognized diabetes education program to marketing DSMT services, and shows how to put these steps into practice.
• CDC’s DSMES Toolkit: This DSMES Toolkit from the Centers for Disease Control and Prevention (CDC) is a comprehensive resource for achieving success in Diabetes Self- Management Education and Support (DSMES). Expanded use of DSMES can help ensure that all people with diabetes receive the support they need.

Frequently Asked Questions

• DSMT Frequently Asked Questions: See answers to some of the most commonly-asked questions about using the Self-Management Resource Center's DSMP as the core curriculum of an expanded DSMT program to meet the national accreditation standards and to receive Medicare reimbursement. 

Tip Sheets

• DSMT Tip Sheet: Learn to develop and operate DSMT programs that meet CMS guidelines for Medicare reimbursement.
• 2017 National Standards for Diabetes Self-Management Education and Support (DSMES) Items for Consideration for Accredited Self-Management Resource Center (SMRC) Model Programs
• Handling Common Objections to Community-Based DSMT

Sample Processes and Agreements

• Sample Policy and Procedure Manual for Diabetes Self-Management Education Program: Use this sample to craft a policy and procedure manual for your organization.
• Sample Diabetes Self-Management Training (DSMT) Documentation Packet: See samples of documentation needed to successful implement DSMES services.

Planning and Administrative Resources

• DSMT Readiness Review: This resource will help you determine your readiness for DSMT accreditation.
• How to Get a Medicare Provider Number: This resource explains the required forms to obtain a Medicare provider number.
• Break-Even Analysis Worksheet
• Documentation and Billing Processes Guidance for Medicare Part B Benefits

Common Abbreviations

ACO Accountable Care Organization

ADA American Diabetes Association

ADCES Association of Diabetes Care & Education Specialist 

BC-ADM Board Certification in Advanced Diabetes Management

CDCES Certified Diabetes Care Education Specialist

CEUs Continuing Education Units

CMS Centers for Medicare & Medicaid Services

CQI Continuous Quality Improvement

DEEP Diabetes Empowerment Education Program

DSMES Diabetes Self-Management Education and Support

DSMT Diabetes Self-Management Training

DSMP Diabetes Self-Management Program (the Self-Management Resource Center DSMP model)

DPP Diabetes Prevention Program

EHR Electronic Health Record

FQHC Federally Qualified Health Center

HEDIS Healthcare Effectiveness Data and Information Set

HRSA Health Resources & Services Administration

IPA Independent Practice Association MAC Medicare Administrative Contractor

MAC Medicare Administrative Contractor

MNT Medical Nutrition Therapy

MSO Management Services Organization

NPI National Provider Identifier

PGHD Patient-Generated Health Data

PTAN Provider Transaction Access Number

QIN-QIOs Quality Innovation Network-Quality Improvement Organizations

RD Registered Dietitian

RN Registered Nurse

RPh Registered Pharmacist

UDA Uniform Data System Report