Diabetic Eye Disease Program Closeout Procedures for Nominators and Providers
The Texas Department of State Health Services (DSHS) has been impacted by funding reductions and program changes requiring a full review and assessment of all available funds and business requirements. As a result, effective September 1, 2011, DSHS is not able to provide funding support for the Diabetic Eye Disease Program in the next fiscal year (FY 2012).
Below are some closeout procedures to assist in a successful transition after September 1, 2011:
- All claims for services provided in fiscal year 2011, which ends August 31, 2011, will be processed.
- Notify patients, as appropriate, that services provided through the DSHS Diabetic Eye Disease Program will not be available after August 31, 2011.
- All claims for services provided in fiscal year 2011 must be received at DSHS by November 1, 2011.
- Claims for services provided after August 31, 2011, will not be accepted.
- Destroy all remaining voucher forms or return them to DSHS.
- Notify patients, as appropriate, that services provided through the DSHS Diabetic Eye Disease program will not be available after August 31, 2011.
- Refer patients to resources for eye care information and assistance found on page 11 of the Resources for Persons with Diabetes document found on the diabetes home page.
Proliferative diabetic retinopathy is the leading cause of blindness in the United States among adults 25 to 74 years of age. In Texas, it is estimated that as many as 1,900 Texans will go blind each year as a result of this condition.
The Diabetic Eye Disease Program (DEDP) helps prevent blindness by providing annual funduscopic examinations to people with diabetes. In a funduscopic examination, the pupil is dilated, allowing an ophthalmologist or trained optometrist to see the back of the eye and identify proliferative diabetic retinopathy (damage to the blood vessels in the retina) and other conditions that can lead to blindness.
The DEDP pays for up to three eye examinations in a 12-month period for Texas residents who have incomes below 150 percent of poverty and lack other third-party coverage. Children also are eligible. Approximately 350 ophthalmologists and licensed optometrists in Texas participate in the program.
The DEDP has grown substantially over the last seven years. The number of eye examinations increased from 2,996 in fiscal year 1995 to more than 6,300 in fiscal year 2001.
In addition to the funduscopic eye examination, participating optometrists and ophthalmologists provide:
- history of visual symptoms;
- visual acuity evaluation;
- assessment of visual field, muscle function, and lens opacity;
- measurement of intraocular pressure;
- eye pathology classification; and
- recommendations for treatment/care.
||Diabetic Eye Disease Program Brochure (PDF, 293 kb, viewing information)
Publication Number E45-10293, Revised 08/2006
| Diabetic Eye Disease Program Manual . . . . . . Publication Number E45-12612, Revised 08/2007
The Diabetic Eye Disease Program Manual contains program guidelines and commonly used forms with instructions for program nominators and providers.
Nominators are staff of Texas Department of State Health Services (DSHS) health service regions, local health departments, and state and federally supported primary care facilities who:
- determine eligibility of program clients,
- refer them to eye care providers
- follow up with clients and providers to assure that eye exams are provided,
- assist clients in obtaining follow-up exams and/or treatment,
- and track clients referred for follow-up
Providers are ophthalmologists and optometrists contracted by DSHS to perform eye examinations for eligible clients referred by nominators.
Download a copy of the Diabetic Eye Disease Program Manual below. Participating nominators and providers will receive printed copies for reference.
||Diabetic Eye Disease Program Manual (High Resolution PDF, 6.4 mb, viewing information)
||Diabetic Eye Disease Program Manual (Low Resolution PDF for faster download. Some graphics may not be legible. 2 mb, viewing information)
||Nominator Application (PDF, 32 kb, Publication Number EDEDP 2)
||Agreement between Provider and Texas Department of Health (PDF, 66 kb, Publication Number EDEDP 4)
||Sample Patient Tracking Form (PDF, 17 kb, Publication Number EDEDP 1)
||Request for Tracking Forms (MS Word, 69 kb, Publication Number EDEDP 6)
|Track It Forward Provider Pilot Project
Track it Forward is a pilot project aimed at improving provider access to DEDP payment tracking information, starting September 1, 2007. A group of providers has been randomly selected to participate in the project, testing new procedures for filing DEDP claims. These providers will receive instructions on how to file claims as part of this initiative. The State of Texas Purchase voucher below is used by providers participating in the project and can be downloaded as needed.
||State of Texas Purchase Voucher - Modified for DEDP billing. (MS Word, 51 kb)
|Diabetic Eye Disease Program Rules