(1) The medicaid agency pays for outpatient hospital-based diabetes education for an eligible client when:
(a) The facility where the services are provided is approved by the department of health (DOH) as a diabetes education center, and
(b) The client is referred by a licensed health care provider.
(2) The agency requires the diabetes education teaching curriculum to have measurable, behaviorally stated educational objectives. The diabetes education teaching curriculum must include all the following core modules:
(a) An overview of diabetes;
(b) Nutrition, including individualized meal plan instruction that is not part of the women, infants, and children program;
(c) Exercise, including an individualized physical activity plan;
(d) Prevention of acute complications, such as hypoglycemia, hyperglycemia, and sick day management;
(e) Prevention of other chronic complications, such as retinopathy, nephropathy, neuropathy, cardiovascular disease, foot and skin problems;
(f) Monitoring, including immediate and long-term diabetes control through monitoring of glucose, ketones, and glycosylated hemoglobin; and
(g) Medication management, including administration of oral agents and insulin, and insulin startup.
(3) The agency pays for a maximum of six hours of individual core survival skills outpatient diabetes education per calendar year per client.
(4) The agency requires DOH-approved centers to bill the agency for diabetes education services on the UB92 billing form using the specific revenue codes designated and published by the agency.
(5) The agency reimburses for outpatient hospital-based diabetes education based on the individual hospital's current specific ratio of costs-to-charges, or the hospital's customary charge for diabetes education, whichever is less.
[Statutory Authority: RCW 41.05.021
. WSR 15-18-065, § 182-550-6400, filed 8/27/15, effective 9/27/15. WSR 11-14-075, recodified as § 182-550-6400, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050
, and Public Law 104-191. WSR 03-19-043, § 388-550-6400, filed 9/10/03, effective 10/11/03. Statutory Authority: RCW 74.08.090
, [74.09.]500, [74.09.]530 and 43.20B.020
. WSR 98-01-124, § 388-550-6400, filed 12/18/97, effective 1/18/98.]