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 for each member each calendar year without prior authorization. Additional units of DSMT may be authorized in accordance with the prior authorization process as set forth in 405 IAC 5-3.

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

1. (1) Receiving a diagnosis of diabetes.
2. (2) Receiving a diagnosis that represents a significant change in the patient's symptoms or condition.
3. (3) Reeducation or refresher training.

(Office of the 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, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA; errata filed Nov 1, 2016, 9:36 a.m.: 20161109-IR-405160493ACA; readopted filed Jul 28, 2022, 2:21 p.m.: 20220824-IR- 405220205RFA; readopted filed May 30, 2023, 11:54 a.m.: 20230628-IR-405230292RFA; filed Jan 22, 2025, 4:31 p.m.: 20250219-IR-405240380FRA)