Diabetes Education Program Sample Clauses
The Diabetes Education Program clause establishes the requirement for providing educational resources and support to individuals diagnosed with diabetes. Typically, this clause outlines the scope of educational services, such as counseling on nutrition, medication management, and lifestyle modifications, and may specify who is eligible to participate or how the program is delivered (e.g., in-person sessions or online modules). Its core function is to ensure that patients receive the necessary information and guidance to effectively manage their condition, thereby improving health outcomes and reducing the risk of complications.
Diabetes Education Program. When the Member’s Physician certifies that a Member requires diabetes education as an Outpatient, coverage is provided for the following when rendered through a Diabetes Education Program:
a. Visits Medically Necessary and Appropriate upon the diagnosis of diabetes; and
b. Subsequent Visits under circumstances whereby a Member’s physician:
i) identifies or diagnoses a significant change in the Member’s symptoms or conditions that necessitates changes in a Member’s self-management; or
ii) identifies, as Medically Necessary and Appropriate, a new medication or therapeutic process relating to the Member’s treatment and/or management of diabetes.
Diabetes Education Program an Outpatient program of self-management training and education, including medical nutrition therapy, for the treatment of diabetes. Such Outpatient program must be conducted under the supervision of a licensed health care professional with expertise in diabetes. Outpatient diabetes education Services will be covered subject to the criteria of the Plan. These criteria are based on the certification programs for Outpatient diabetes education developed by the American Diabetes Association and the Pennsylvania Department of Health.