405 IAC 5-36-3 - Limitations on coverage of DSMT

Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-21-3

Affected: IC 12-15; IC 27-8-14.5

Sec. 3.

(a) Coverage of DSMT is limited to sixteen (16) units of DSMT per member, per rolling calendar year without prior authorization. Additional units of DSMT may be authorized via the prior authorization process as set forth in 405 IAC 5-3.

(b) Coverage of DSMT is limited to the following clinical circumstances:

(1) Receipt of a diagnosis of diabetes.

(2) Receipt of a diagnosis that represents a significant change in the patient's symptoms or condition.

(3) Re-education or refresher training.

Notes

405 IAC 5-36-3

Office ofthe Secretary of Family and Social Services; 405 IAC 5-36-3; filed Sep 27, 1999, 8:55 a.m.: 23 IR 323; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA Errata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACA Readopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFA Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA