April 1, 2015, Mississippi Medicaid began reimbursing for DSMT. This really is a great thing . . . if only they had made it simple vs going down a path of a different set of rules.
For the last 2 - 3 years I’ve been actively engaged with the Diabetes Coalition of Mississippi. I felt the best way to advocate for persons engaged in diabetes self-management education / training was to make sure I some idea what was going on in the state. As you can imagine, there is a lot of confusion regarding DSME/T, national standards, CDE and BC-ADM certifications, etc. I felt MSAADE’s participation on this statewide organization would only benefit those persons practicing DSME/T, those that want to practice DSME/T, providers referring to DSME/T and lastly, but certainly not the least, those persons and families living with diabetes.
There are multiple groups working within the DCM; MSAADE was always available to answer questions about DSME/T and/ or reimbursement. Toward the end of February of this year I was asked to review the Medicaid ruling on DSMT reimbursement. The changes I recommended would have been those that made this ruling almost identical to being reimbursed by Medicare. (Medicaid prior authorization could stay - a barrier for sure but I reasoned Medicaid didn’t really know what it was getting into and that a PA in the beginning could be survived).
What I didn’t know until mid-April is the ruling was a done deal by time it was forwarded to me for review. Regretfully, I do not know if anyone on the committee was truly knowledgeable about the national standards and/or reimbursement criteria. Efforts to retrieve a roster of participants has not been successful.
When it comes to reimbursement, there are few more knowledgeable than Amy Keywood, RD, LD, CDE in Hazlehurst. Efforts to retrieve implementation instructions from Medicaid were not reassuring.
So, what do the numbers look like?
- We have 36 accredited or recognized DSME/T programs in Mississippi.
- 17 of these sites are associated with a hospital but may not actually be provided through that facilities outpatient services . . . < 17 sites are eligible for Medicaid reimbursement in the state that has remained at the top of diabetes prevalence and Medicaid beneficiaries for . . . forever?
- The Mississippi State Department of Public Health, who has recently acquired DEAP accreditation, would most certainly benefit from DSME/T reimbursement via Medicaid, but they aren’t eligible.
- The Federally Qualified Health Centers . . . not eligible . . .
- Choctaw Health Center . . . no . . .
- Pharmacies . . . no.
Comments?