Contract Type: Diabetes Education Training
The contractor and contractor staff that provide services described in this chapter also must comply with Chapters 1–3 of the VR Standards for Providers manual.
On this page:
Diabetes self-management education is the process of developing the customer's knowledge, skills, and abilities that are necessary to manage diabetes and improve his or her health outcomes. Vocational Rehabilitation (VR) customers might require education about diabetes to address the cause of the disease. Diabetes self-management education provides adaptive techniques and/or equipment to help the customer self-manage his or her diabetes.
Assessment and teaching of blood sugar monitoring, medication delivery, and other self-care skills related to diabetes self-management require close, hands-on evaluation and training when working with individuals who are blind or visually impaired.
Diabetes self-management education services are based on the American Association of Diabetes Educator's 7 Self-Care Behaviors™, which are:
The diabetes self-management education services are for customers who:
Any request to change a Service Definition, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director, using the VR3472, Contracted Service Modification Request for Blind and Visually Impaired Services, before the change is implemented. The approved VR3472 must be maintained in the provider’s customer case file. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
Before any services are provided, the service provider director must approve the VR3455, Provider Staff Information form, completed by staff such as a trainer and aides, and submit the approved form to the provider's assigned contract manager and assigned regional program specialist. The VR3455 documents the provider's qualifications and provides evidence of meeting those qualifications by providing the:
A diabetes educator must have at least one year of paid experience providing diabetes education as an essential function of the job while currently licensed as a:
The diabetes educator must have continuing education units (CEUs) in diabetes self-management education topics from an agency approved by the diabetes educator's licensing or certifying body. The CEUs may not include the Texas Confidence Builder training.
Diabetes Educator |
CEUs Required |
Frequency |
---|---|---|
Registered Nurses |
15 |
Within the 12 months immediately preceding the contract date and an additional 15 hours within the term of the contract |
Registered Dieticians |
15 |
Within the 12 months immediately preceding the contract date and an additional 15 hours within the term of the contract |
Certified Diabetes Educator |
10 |
Within the 12 months immediately preceding the contract date and an additional 10 hours within the term of the contract |
All diabetes educators must attend and participate in the VR Texas Confidence Builder Training. This 14-hour training is completed before a contract is awarded or before services are provided by the diabetes educator, and the training must be retaken every two years.
If the Texas Confidence Builder training is not available at the two-year renewal date, the VR diabetes program specialist and the contract manager must request that the requirement be waived or postponed. The request must be documented and approved by the VR director using VR3490, Temporary Waiver of Credentials.
VR does not pay the provider's travel costs for transportation, food, and lodging to attend Texas Confidence Builder Training or other trainings.
A diabetes self-management assessment is the diabetes educator's evaluation of a customer's ability to manage the diabetes. The assessment must gather information about the customer's:
A diabetes self-management assessment is provided in person with the trainer and customer at the same location. The diabetes self-management assessment may be provided remotely only with a VR director approved VR3472, Contracted Service Modification Request. Remote services must follow VR-SFP 3.4.8 Remote Service Delivery.
Any request to change a Service Definition, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director, using the VR3472, Contracted Service Modification Request for Blind and Visually Impaired Services, before the change is implemented. The approved VR3472 must be maintained in the provider’s customer case file. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
For more information refer to VR-SFP 3.4.11 Contracted Services Modification Request.
For information on acceptable signatures refer to VR-SFP sections 3.2.14 Documentation and 3.2.16 Signatures.
It is recommended that the diabetes educator use adaptive equipment and disposable supplies for demonstration during the assessment. The suggested items include:
The customer and instructor develop an education and support plan that is created from evidence-based approaches for effective health communication and education while taking into consideration the customer's barriers to self-management, abilities, and expectations as well as information from the diabetes self-management assessment. (ADA, 2016)
The initial diabetes self-management assessment helps the diabetes educator recommend the skills training from which the customer would benefit. The training areas include information and skills relating to:
The initial assessment should evaluate all the above topics. The training plan should recognize the partial or complete deficits in self-management knowledge and identify the specific deficits that should be addressed. If the results of the initial diabetes self-management assessment warrant, training may begin immediately if:
Should the provider of the diabetes education training be different from the provider who conducted the initial assessment, the VR2888, Diabetes Self-Management Education Assessment, and the VR2901, Diabetes Self-Management Pre- and Post-Assessment, should be reviewed by the new provider prior to initiating diabetes education training.
If the new diabetes educator does not agree with the original assessment recommendations, a consultation between the VR counselor, new diabetes educator, and state office program specialist for diabetes education is scheduled to establish an agreement on appropriate diabetes education for the VR customer.
The initial diabetes self-management assessment may be conducted before or after eligibility is determined.
The diabetes self-management assessment provider begins services once a signed VR service authorization and a VR2883, Diabetes Self-Management Education Referral form, completed by the VR counselor, or the Independent Living Services for Older Individuals Who Are Blind (ILS-OIB) worker, have been received.
The VR2883, Diabetes Self-Management Education Referral Form:
The initial diabetes self-management assessment must not exceed two hours and must be held for each customer individually.
The provider must discuss additional hours with the VR counselor or the ILS-OIB worker and the VR diabetes program specialist. The request must be documented and approved by the VR director using VR3472, Contracted Service Modification Request.
The diabetes educator develops a written education and support plan in the Overall Recommendations section of VR2888, Diabetes Self-Management Education Assessment.
VR staff and the diabetes educator ensure that the education and support plan is appropriate, based on the customer's:
Diabetes educators must use the talking blood-glucose meter recommended by the VR state office diabetes program specialist to:
If the diabetes educator recommends using a different type of talking meter, the VR diabetes program specialist must authorize the purchase before the equipment is purchased and skills training occurs.
The diabetes educator completes the assessment of the customer's ability to manage the diabetes and makes recommendations for training, equipment, and services using VR2888, Diabetes Self-Management Education Assessment. The assessment report must be submitted to VR within 35 days of completion of the assessment.
Behavior change goal setting empowers the customer to fully engage in personal problem solving to change behavior and improve outcomes. Using person centered, informed decision making, the diabetes educator guides the customer in the skill of goal setting by assisting them to
An initial behavior change goal must be set at the initial assessment. This is the customer’s goal and action plan.
If the diabetes educator cannot schedule the visit with the customer to initiate the assessment within three calendar weeks, then the educator must notify the VR counselor by email, paper mail, or fax. VR may determine that it is necessary to cancel the service authorization and identify a new provider.
The diabetes educator documents the two-hour initial diabetes self-management assessment and other findings for each customer on the:
All forms must be completed in their entirety for the provider to be paid. As appropriate, the provider uses the following notations:
The initial assessment fields are completed on the VR2901. The form is saved electronically so that the post-assessment fields can be completed later.
The VR2888, Diabetes Self-Management Education Assessment, reports the information that the diabetes educator captured during the initial assessment as well as the recommendations for equipment and training.
The VR2901, Diabetes Pre- and Post-Assessment, allows a comparison of the customer's knowledge of diabetes management before and after training.
For more information, refer to 7.6 Diabetes Self-Management Education Services Fee Schedule.
Diabetes skills training is provided by a diabetes educator who instructs and counsels the customer and family by means of individual and/or group skills training sessions that have been authorized by means of a service authorization.
Diabetes skills training is provided in person with the trainer and customer at the same location. The diabetes skills training may be provided remotely only with a VR director-approved VR3472, Contracted Service Modification Request. Remote services must follow VR-SFP 3.4.8 Remote Service Delivery.
Any request to change a Service Definition, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director, using the VR3472, Contracted Service Modification Request for Blind and Visually Impaired Services, before the change is implemented. The approved VR3472 must be maintained in the provider’s customer case file. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
For information on acceptable signatures refer to VR-SFP sections 3.2.14 Documentation and 3.2.16 Signatures.
Diabetes skills training is intended to:
Diabetes skills training helps customers set goals and make effective health and care decisions that fit their values and lifestyles. Diabetes educators help customers:
The number of training hours recommended for individual diabetes self-management is based on:
Up to 12 hours of skills training for diabetes self-management can be provided:
Diabetes educators are reimbursed only for the time spent teaching customers. Trainers are not reimbursed for:
The VR counselor or the ILS-OIB worker submits a referral and issues service authorizations for diabetes skills training.
The diabetes educator must divide all diabetes skills training into two-hour segments to ensure that the segments do not fatigue the customer and consequently reduce the benefit of the skills training.
The diabetes educator helps the customer develop specific, measurable, achievable, realistic, and timely (SMART) goals.
A new behavior-change goal should be set at each visit between the educator and the customer and achievements evaluated at the next visit. The diabetes educator helps the customer overcome barriers to success and employ problem-solving strategies.
It is recommended that the diabetes educator use adaptive equipment and disposable supplies for demonstration during training such as:
The diabetes educator documents the provision of education materials, resources, and referrals on VR2884, Diabetes Self-Management Educator Notes.
The VR counselor or the ILS-OIB worker is responsible for approving the purchase of the recommended equipment or supplies. Documentation should identify:
If the customer is unable to participate in skills training on diabetes self-management because of his or her health, the diabetes educator must inform the VR counselor by email, paper mail, or fax within three business days. The diabetes educator must document such notification in the customer's file.
Service providers must document each two-hour skills training session provided to each customer using VR2884, Diabetes Self-Management Educator Notes.
A complete and accurate invoice may be submitted after completion of the services. All required documentation must be submitted within 35 calendar days of the date that the service is provided, including initial assessment, skills training, and post-training assessment.
If the diabetes self-management education services include providing the customer with a talking blood-glucose meter or other diabetes equipment, the diabetes educator must:
For more information, refer to 7.6 Diabetes Self-Management Education Services Fee Schedule.
The post-training assessment is the final meeting provided for diabetes services. In this one-hour assessment, the customer and diabetes educator develop a follow-up plan for ongoing support. The plan includes information about goals, educational and equipment outcomes, and ongoing needs.
The diabetes educator conducts post-training assessments no sooner than 30 calendar days after the skills training is complete.
As part of the post-training assessment, the diabetes educator:
The post-training assessment must be completed for all customers 30 days after the last training session. The post-training assessment may be completed in person, by phone, or by video conferencing with the customer as described in VR-SFP 3.4.8 Remote Service Delivery. The preferred method to complete the post-training assessment is in person. If a post-training assessment must be provided sooner than 30 calendar days after the skills training, the trainer must request approval from the referring VR counselor or the OIB worker before the post assessment being completed. The VR counselor or OIB worker requests approval from the VR director using VR3472, Contracted Service Modification Request for Blind and Visually Impaired Services.
Any request to change a Service Definition, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director, using VR3472, Contracted Service Modification Request for Blind and Visually Impaired Services before the change is implemented. The approved VR3472 must be maintained in the provider's customer case file. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
For more information on acceptable signatures, refer to VR-SFP sections 3.2.14 Documentation and 3.2.16 Signatures.
To document the one-hour post-training assessment, the diabetes educator completes the:
To evaluate the customer's progress, the post-assessment fields are completed on the same VR2901, Diabetes Pre-and Post-Assessment that was submitted at the initial assessment.
The following documentation must be submitted within 35 calendar days of completion of the post-training assessment:
The provider documents all conversations that he or she has had with the VR counselor, the OIB worker, and other staff about customers whom that provider is serving.
For more information, refer to 7.6 Diabetes Self-Management Education Services Fee Schedule.
Diabetes Self-Management Education Services |
Unit Rate |
Comment |
---|---|---|
Diabetes Self-Management Assessment |
$117.00 per hour |
|
Diabetes Skills Training (Individualized Services Only) |
$117.00 per hour |
|
Diabetes Skills Training (Group Services Only) |
$60.00 per hour |
|
Post-training Assessment |
$117.00 per hour |
|