Common use of Diabetes Services Clause in Contracts

Diabetes Services. Diabetes Self-Management and Training and Education Services "Diabetes self-management training and educational services" means instruction in an inpatient or outpatient setting which enables diabetic patients to understand the diabetic management process and daily management of diabetic therapy as a method of avoiding frequent hospitalizations and complications, when the instruction is provided in accordance with a program in compliance with the National Standards of Diabetes Self-Management Education Program as developed by the American Diabetes Association. Diabetes self-management training and educational services includes coverage for medical nutrition therapy when prescribed by a health care professional and when provided by a certified, registered or licensed health care professional. Diabetes self-management training and educational services does not include programs with the primary purpose of weight reduction. Benefits also include medical eye exams (dilated retinal exams) and preventive foot care, and diabetic specific foot orthotics, orthopedic shoes, inserts, modifications, and footwear when Medically Necessary for the treatment of complications related to diabetes. Outpatient self-management training for the treatment of diabetes, education and medical nutrition therapy services when services are ordered by a Physician and provided by appropriately licensed, certified or registered health care professionals. The provider certifies the services are necessary for the treatment of: • Insulin using diabetes; • Non-insulin using diabetes; • Elevated or impaired blood glucose levels induced by Pregnancy; or • Elevated or impaired blood glucose levels induced by prediabetes in accordance with the American Diabetes Association’s standards. Diabetes self-management training includes training provided to you after the initial diagnosis of diabetes and or Pregnancy induced elevated blood glucose levels in the care and management of those conditions, including nutritional counseling and proper use of the diabetic self-management items listed below. Benefits are also provided for additional training upon diagnosis of a significant change in medical condition that requires a change in the self- management regime, and periodic continuing education training as warranted by the development of new techniques and treatment for diabetes. Diabetic Self-Management Supplies Benefits for blood glucose control and testing including insulin syringes with needles, blood glucose and urine test strips, lancets and lancet devices, ketone test strips and glucose tablets, single measurement glucose monitors, including those for the legally blind, and certain insulin pumps, are described under the Outpatient Prescription Drugs section. Continuous glucose monitors are excluded as described under the Outpatient Prescription Drugs section. Continuous glucose monitors and certain insulin pumps are subject to all the conditions of coverage stated under Durable Medical Equipment (DME).