Medicaid reimbursement?

[SteveDE]

I'm working on gaining information on how or IF Medicaid provides any reimbursement for diabetes self-management education or medical nutrition therapy? I know this could be state specific, so more comments, the better. I am in Illinois and my understanding is Illinois Medicaid does not provide any reimbursement for DSMT or MNT.

As a facility, we will provide education to anyone regardless of ability to pay, but I'm sure there are plenty of facilities that don't or can't do this. How do your facilities handle Medicaid reimbursement issues?

[SteveDE]

Hey SteveDE, I know at least at our facility we don't get reimbursement for DE or MNT for people with Medicaid only. We still provide the services to them because we know that by providing the service to them we are helping them become and stay healthier/happier patients and members of our community.

[SteveDE]

Hey SteveDE, from what Illinois Medicaid has told me is they do not cover any diabetes education or medical nutrition therapy since they do not recognize nurses or registered dieticians as providers. The only way there is any reimbursement is when the medical provider (doctor, NP, or PA) gives "counseling" during a billable office visit, so during their whopping 15 minute office visit the medical provider can choose to do counseling that they could provide a different E&M code.

[Mudwoman]

In Arkansas, Medicaid does not pay for any education unless it is by the physician in the clinic setting. Then the physician can charge a level 3 visit for including the education. This year, Medicaid no longer pays for blood glucose testing supplies either. (in Arkansas). How crazy is that.

Medicare will pay for 13 hours of education the first year the patient is diagnosed and then 2 hours of education each year thereafter. The patient's deductibles and co-pays apply. Medicare pays us 20% of what we charge for education.

Lots of private insurance companies no longer pay for Diabetes Education either. They will pay for Medical Nutrition Therapy by a Registered Dietician. Many insurance companies provide some type of diabetes education for their enrollees at no charge. If they do pay, it is often a one time payment.