CALIFORNIA DIABETES
&
PREGNANCY PROGRAM
“CDAPP SWEET SUCCESS”
APPLICATION
to BECOME A CDAPP
SWEET SUCCESS AFFILIATE
2015
Overview: The California Diabetes
and Pregnancy Program (CDAPP)
Sweet Success

History:
CDAPP Sweet Success began as a pilot project in San Francisco in 1982, funded
by the March of Dimes. Based on the success of that pilot project, the Inland
Counties in Southern California became the first CDAPP regional program funded
by federal Title V Block Grant through the California Maternal, Child and
Adolescent Health (MCAH) Division.
CDAPP Sweet Success regional programs were originally established based on the
regional perinatal health systems model. The regional program consisted of a
multidisciplinary team that ideally included a diabetes nurse educator, a registered
dietitian, and a behavior medicine specialist who worked in conjunction with a
regional medical director. Due to budget shortfall, funding for ten regional
CDAPP Sweet Success programs ended in June 2012. A new statewide CDAPP
Sweet Success Resource and Training Center was established starting July 1, 2012
to support and train our CDAPP Sweet Success Affiliates.
The CDAPP Sweet Success Resource and Training Center develops and maintains
web-based training and disseminates valuable diabetes resources.
CDAPP Sweet Success Affiliates provide direct health services that promote
optimal management of diabetes, before, during, and after pregnancy. Affiliates
are encouraged to:
 Use the CDAPP Sweet Success Guidelines for Care.
 Utilize interdisciplinary health care teams to provide preventive and health
promoting strategies that are culturally appropriate and research-based.
 Collect and analyze clinical data for validation of services to patients and for
quality improvement (QI) activities.
CDAPP Sweet Success
Affiliation Application Background
Mission:
The mission of the California Diabetes and Pregnancy Program (CDAPP) Sweet
Success is to promote best practices of care for pregnant women who have
diabetes. CDAPP Sweet Success strives to optimize maternal and neonatal birth
outcomes, and reduce the complications of diabetes among women with
preexisting diabetes and slow or prevent the development of ongoing diabetes
among women with gestational diabetes.
Goals:
CDAPP Sweet Success goals are:
 To improve pregnancy outcomes for high-risk pregnant women who have
preexisting diabetes or who develop gestational diabetes during pregnancy,
 To reduce fetal deaths and neonatal and maternal complications due to
diabetes.
We accomplish these goals through the CDAPP Sweet Success Resource and
Training Center which:

Develops updates and disseminates CDAPP Sweet Success Guidelines for
Care that provides guidelines to care for women with diabetes before, during
and following pregnancy.

Recruits, educates, and provides technical assistance to CDAPP Sweet Success
Affiliates who provide clinical care to pregnant women with diabetes. Clinical
care provided by CDAPP Sweet Success Affiliates includes comprehensive
individualized services such as outpatient health education, nutrition,
psychosocial and medical services.

Develops ethnic/language specific professional and patient education
materials, and resources.

Promotes awareness of the importance of preconception care for women with
pre-existing diabetes.

Collaborates with the Comprehensive Perinatal Services Program, (CPSP), the
California Diabetes Program (CDP) and other appropriate networks.
These goals are consistent with those of the California Department of Public
Health, Maternal, Child and Adolescent Health Division funded through Federal
Title V Block Grant.
CDAPP Sweet Success Affiliate
Role of the Team
CDAPP Sweet Success Affiliates use a multidisciplinary team. The team is
comprised of various health care professionals, depending on the health care
setting, and can include physicians, nurse educators, nurse practitioners, certified
nurse midwives, health educators, physician assistants, behavioral medicine
specialists (social workers, marriage/family therapists, and clinical psychologists),
registered dietitians, and medical assistants. The roles of these team members
may overlap in some cases, but all team members work closely with the woman
throughout her pregnancy. Team members need understanding of the physiology
and management of pregnancies complicated by diabetes as well as experience in
educating women about diabetes related issues.
MCAH provides:
 Title V federal funding for CDAPP Sweet Success Resource and Training
Center
 Program Consultants for CDAPP Sweet Success who provide direction
and oversight in communicating the MCH Title V goals and objectives to
the CDAPP Sweet Success Resource and Training Center.
CDAPP Sweet Success Resource and Training Center provides:
 The “CDAPP Sweet Success Guidelines for Care”,
 The CDAPP Sweet Success Resource and Training Center Website.
 The CDAPP Sweet Success materials and brochures to affiliates and
providers in electronic formats.
 Web-based educational trainings for existing and new CDAPP Sweet
Success Affiliates
 Assistance to affiliates in order to maintain their Memorandum of
Understanding (MOU) and inclusion in the online CDAPP Sweet Success
Affiliate Directory.
 Collection of CDAPP Sweet Success Affiliate On-line Annual Surveys
including number of clients served.
 Annual Certificates of Affiliate Status that can be displayed verifying the
site has met requirements.
 An Annual Report to the MCAH Division.
CDAPP Sweet Success Affiliates provide:
 A health care team knowledgeable about the CDAPP Sweet Success
Guidelines for Care and utilizes these guidelines in their current practice.
 Patient management based upon participation in CDAPP Sweet Success
training programs.
 Comprehensive clinical preconception and pregnancy care for women
with diabetes
 Clinical competency by ongoing participation in yearly educational
programs.
 Data collection about the care they provide to clients in order to selfmonitor and evaluate their clinical practices.
 Feedback and sharing of their goals and plans with the CDAPP Sweet
Success Resource and Training Center staff through annual on-line site
survey.
 Promotion of diabetes awareness in the community and participation in
diabetes educational programs
Cost Effectiveness:
Studies have shown that $3.00 to $5.00 is saved for every $1.00 spent on diabetes
and pregnancy care. (Kitzmiller JL. Pre-conception care of diabetes, congenital
malformations, and spontaneous abortions. Diabetes Care. 1996;19(5):514-541.)
Resources:
CDAPP Sweet Success Web sites
http://www.cdph.ca.gov/programs/cdapp/Pages/default.aspx
CDAPP Sweet Success Resource and Training Center website:
http://www.cdappsweetsuccess.org/
CDAPP Sweet Success
AFFILIATION APPLICATION
PROCESS

 Complete a CDAPP Sweet Success Affiliation Application and submit it to
the CDAPP Sweet Success Resource and Training Center.
 Following application review and approval by the CDAPP Sweet Success
Resource and Training Center, a Memorandum of Understanding (MOU) that
describes what is required of an affiliate and the support that is provided by
CDAPP Sweet Success Resource and Training staff will be sent to you. The
MOU is to be signed by both a representative of your program and the
CDAPP Sweet Success Resource and Training Center.
 All affiliate staff, and all new staff as they become part of your team, who
have not already attended CDAPP Sweet Success required training will need
to do so within one year of affiliation.
 After training is completed, your site will be added to the CDAPP Sweet
Success Resource and Training Center and to the State CDAPP Sweet Success
web sites as part of the CDAPP Sweet Success Affiliate Directory.
 Follow-up consultation will be provided by CDAPP Sweet Success Resource
and Training Center staff on an as needed basis.
 An On-Line Annual Survey will be conducted by the CDAPP Sweet Success
Resource and Training Center to assess and provide assistance to your
program. (Refer to the CDAPP Sweet Success On-Line Annual Survey).
Memorandum of Understanding (MOU) – the MOU details the agency’s
agreement to:
 Follow CDAPP Sweet Success Guidelines for Care
 Ensure all affiliate staff are trained in the care of women with diabetes
 Participate in on-line annual site survey by CDAPP Sweet Success Resource
and Training Center staff including data regarding number of clients served.
CDAPP Sweet Success
AFFILIATION APPLICATION*
Click here to enter a date.
Date
Agency Name
Street Address
Telephone/Fax
Email Address
Type of Agency
MD Office
(double click to check box)
Diabetes Center
Name/Credentials
Email
Medical Center Clinic
Other:
Phone
Languages
Spoken
Community Clinic
FTE
in SS
Hrs/Days
in SS
Medical Director
(Must be a practicing
physician who sees
diabetic patients)
CDAPP Sweet
Success Program
Coordinator/ Contact
(must be licensed)
Dietitian(s)
Nurse Educator(s)
Behavioral Medicine
Specialist(s)
Obstetrician(s)
Endocrinologist
Others
* Please indicate with an * who will be the designated person to initiate and finalize data collection. Also, to
check any box in this fill-in document, just scroll over that box with your mouse and double click. A window
should pop up allowing you to check that given box.
CDAPP Sweet Success
AFFILIATION APPLICATION
To check any box in this fill-in document, just scroll over that box with your
mouse and double click. A window should pop up allowing you to check that
given box.
1. Services you plan to provide. Check the services you will provide:

Preconception counseling for:
Type 1 diabetes
Type 2 diabetes

Antepartum
Type 1 diabetes
Type 2 diabetes

Intrapartum
Type 1 diabetes
Type 2 diabetes
GDM

Postpartum medical management of:
Type 1 diabetes
Type 2 diabetes
GDM

Medical nutrition therapy for complex situations (e.g. multiples,
hyperemesis)

Diabetes self-management education (includes meal planning, physical
activity planning, how to take medication, coping support, problem-solving
strategies, how to reduce risks, self-monitoring of blood glucose (SMBG)

Continuous subcutaneous insulin therapy

Other Services: Click here to enter text.
2.
Volume of patients you expect
Expected number of new patients per month with GDM
Expected number of new patients per month with Type 1 diabetes
Expected number of new patients per month with Type 2 diabetes
3.
Program accepts Medi-Cal?
Yes
No If yes, are you a CPSP provider?
Yes
4.
Site is part of an ADA recognized diabetes program?
5.
Will you have a budget for purchasing education materials?
No
Yes
No
Yes
No
All of our educational materials are made free to download from our website
at no cost to you. The cost you would incur is printing it out on your own (i.e.
ink, paper and time) or utilizing an outside printing company.
6.
Identify referral sites/resources for clients who need care which you are unable
to provide with on-site staff. This may include the following: (Indicate names
and location of such resources.)
 Perinatologist
 Endocrinologist
 Psychosocial practitioners
 Public health resources
7.
Identify the hospital(s) in which your clients will deliver:
DETERMINING FTE NEEDS FOR THE
SWEET SUCCESS PROGRAM
The full-time equivalent (FTE) calculations for staff in a CDAPP Sweet Success
Affiliate include those needed for patient education and services.
A CDAPP Sweet Success Affiliate needs designated staff to address and provide
services including nursing (RN), dietitian (RD), and behavioral medicine
specialist (BMS). The mix of patients usually includes some that are there for the
initial visit and some that are there for follow-up visits. Some patients will only
require diet and activity management, while others will need oral diabetic agents
or insulin. These factors including the total number of patients seen will affect the
FTE calculation.
Generally, an initial educational visit will be about 2 hours comprised of about 45
-60 minutes for the RN, about 30-45 minutes for the RD, and about 30 minutes for
the BMS.
For a new patient requiring insulin teaching another 60 minutes may be needed.
Follow-up visits at 1-2 week intervals usually are about 15-30 minutes.
To determine FTE needed, calculate:
 # New patients per week x 2 hours.
 # New patients on insulin per week x 1 hour.
 # F/U patients per week x 30minutes.
 # Total hours per week /3 staff (RN, RD, BMS) = # hours each or
about # FTE each.
 # FTE x 3= FTE total time per week.
For example:
In one year, the number of Sweet Success patients seen by a CDAPP Sweet
Success Affiliate was 140 or about 12 new patients per month.
 New patient = 8 hours/week
 New patient on insulin = 9 hours/week
 F/U patient =16 hours/week
 F/U insulin pt = 8 hours/ week
 Total = about 41 hours per week
 41 hours/3 staff (RN, RD, BMS)* = 14 hours each or about .35 FTE
each.
 .35 FTE x 3= a little over 1 FTE total time per week.
*The time needed by type of staff will vary according to individual patient
needs.
Summary of Sweet Success Services by
Service Description and Visit Length
The purpose of this document is to provide a quick summary of the types of client categories, services usually rendered, and codes most often used
when billing for these services. The summary descriptions refer to the average uncomplicated client. If the client seen has complications, the
services codes may need to be modified for additional time spent. We recommend that you work with your billing and compliance department
for consistent billing within your healthcare system and that you are meeting all of the criteria for billing as stated in the Current
Procedural Terminology (CPT) manual using specific CPT codes. This document is intended for use with non-CPSP payers.
Type of Diabetes
Length of Visit
Type of Visit
Preconception with:
Type 1 Diabetes
or
Type 2 Diabetes
2 hours
Initial Visit
Obtain a thorough assessment of the individual lifestyle, capabilities, limitations, diabetes
knowledge and skills, general health and obstetrical history. Provide the woman and her
partner with adequate knowledge for: understanding the possible complications associated
with diabetes and pregnancy; bringing about effective behavioral changes that will lead to
improved diabetes self-care; making appropriate dietary, activity and insulin adjustments
necessary for continued good control of diabetes; planning and early identification of
pregnancy.
CPT Codes:
99205 Initial office visit, new patient OR
99245 Initial office consultation, new or established patient
Please note that you may bill only one of the above codes on the same date of service for the
same beneficiary.
Preconception with:
Type 1 Diabetes
or
Type 2 Diabetes
1/2 – 1 hour
Follow-up in one week to determine effectiveness of the care plan and make adjustments in
diet, exercise, medications as needed. Review and discuss laboratory test, retinal exams,
ECGs, etc., that were ordered at initial meeting in relation to specific individual case,
presenting risk and options as they apply to client. Refer as indicated. Visit of 30 to 60
minutes of face-to-face time.
Type of Diabetes
Length of Visit
Type of Visit
CPT Codes:
99214-99215 Office visit, established patient OR
99242-99244 Office consultation, new or established patient - select CPT code based on
time with the patient and key components of care provided.
Pregnancy with:
Type 1 Diabetes
or
Type 2 Diabetes
2 hours
Initial Visit
Obtain family, medical, and obstetrical history; institute individual self-care plan including
medical nutrition therapy, exercise recommendations, blood glucose monitoring, medication
adjustments, record keeping and psychosocial efficacy with the care plan. Make referrals as
needed.
CPT Code:
99245 Office consultation, new or established patient
Pregnancy with:
Type 1 Diabetes
or
Type 2 Diabetes
1 hour
Pregnancy with:
Type 1 Diabetes
or
Type 2 Diabetes
1/2 – 1 hour
Follow-up in one week to determine effectiveness of the care plan, diet and weight gain
appropriateness, make adjustments in diet, exercise, medications as needed.
CPT Code:
99244 Office consultation, new or established patient
Subsequent follow-ups at one to two week intervals to clarify diet, blood glucose
monitoring, review sick-day rules, provide additional information for breastfeeding/ infant
feeding, future pregnancy planning and continued good health postpartum (i.e., nutrition,
exercise, family planning).
Further follow-up sessions will be determined by blood glucose control, adequacy of
nutritional intake and weight gain, and presence of ketones in the urine, use of sick-day
rules, and any red-flag psychosocial conditions.
CPT Codes:
99242-99244 Office consultation, new or established patient - select CPT code based on
time with the patient and key components of care provided.
Impaired Glucose
Tolerance (IGT) in
1 hour
Initial Visit
Obtain family, medical, and obstetrical history; institute individual self-care plan including
Type of Diabetes
Length of Visit
medical nutrition therapy, exercise recommendations, blood glucose monitoring, record
keeping and psychosocial efficacy with the care plan.
pregnancy:
one abnormal value on the 2
or 3 hr. Oral Glucose
Tolerance Test (OGTT)
GDM:
diet controlled in
pregnancy
Type of Visit
CPT Code:
99244 Office consultation, new or established patient
1 1/2 hours
Initial Visit
Obtain family, medical, and obstetrical history; institute individual self-care plan including
medical nutrition therapy, exercise recommendations, blood glucose monitoring, record
keeping and psychosocial efficacy with the care plan. Make referrals as needed.
CPT Code:
99245 Office consultation, new or established patient
GDM:
Diet controlled in
pregnancy
1 hour
Follow-up in one week to determine effectiveness of the care plan, diet and weight gain
appropriateness, make adjustments in diet, exercise, and determine if medications are
needed.
CPT Code:
99244 Office consultation, new or established patient
GDM:
diet controlled in
pregnancy
1/2 – 1 hour
Subsequent follow-ups at one to two week intervals to clarify diet, blood glucose
monitoring, review sick-day rules, provide additional information for breastfeeding/ infant
feeding, future pregnancy planning and continued good health postpartum (i.e., nutrition,
exercise, family planning).
Further follow-up sessions will be determined by blood glucose control, adequacy of
nutritional intake and weight gain, and presence of ketones in the urine, use of sick-day
rules, and any red-flag psychosocial conditions.
CPT Codes:
99242-99244 Office consultation, new or established patient - select CPT code based on
time with the patient and key components of care provided.
GDM:
on oral hypoglycemic
2 hour
Initial Visit
Obtain family, medical, and obstetrical history; institute individual self-care plan including
Type of Diabetes
Length of Visit
Type of Visit
use of oral hypoglycemic agents, medical nutrition therapy, exercise recommendations,
blood glucose monitoring, record keeping and psychosocial efficacy with the care plan.
Make referrals as needed.
agent/s in pregnancy
CPT Code:
99245 Office consultation, new or established patient
GDM:
on oral hypoglycemic
agent/s in pregnancy
1/2 – 1 hour
Follow-up in one week to determine effectiveness of the care plan, diet and weight gain
appropriateness, make adjustments in diet, exercise, and determine if medications working or
need to switch to insulin.
CPT Codes:
99242-99244 Office consultation, new or established patient - select CPT code based on
time with the patient and key components of care provided.
GDM:
on oral hypoglycemic
agent/s in pregnancy
1/2 – 1 hour
Subsequent follow-ups at one to two week intervals to clarify diet, blood glucose
monitoring, provide additional information for breastfeeding/infant feeding, future
pregnancy planning and continued good health postpartum (i.e., nutrition, exercise, family
planning). Further follow-up sessions will be determined by blood glucose control, adequacy
of nutritional intake and weight gain, and presence of ketones in the urine, use of sick-day
rules, and any red-flag psychosocial conditions.
CPT Codes:
99242-99244 Office consultation, new or established patient - select CPT code based on
time with the patient and key components of care provided.
GDM:
on insulin in pregnancy
2 hours
Initial Visit
Obtain family, medical, and obstetrical history; institute individual self-care plan including
medical nutrition therapy, exercise recommendations, blood glucose monitoring, initial
insulin instruction, record keeping and psychosocial efficacy with the care plan. Make
referrals as needed.
CPT Code:
99245 Office consultation, new or established patient
Type of Diabetes
Length of Visit
Type of Visit
GDM:
on insulin in pregnancy
1 hour
Follow-up in one week to determine effectiveness of the care plan, diet and weight gain
appropriateness, make adjustments in diet, exercise, and determine if insulin adjustments are
needed.
GDM:
on insulin in pregnancy
1/2 - 1 hour
CPT Code:
99244 Office consultation, new or established patient
Subsequent follow-ups at one to two week intervals to clarify diet, blood glucose
monitoring, insulin administration, provide additional information for breastfeeding/ infant
feeding, reduction of risk for Type 2 diabetes, future pregnancy planning and continued good
health postpartum (i.e., nutrition,
exercise, family planning).
Further follow-up sessions will be determined by blood glucose control, adequacy of
nutritional intake and weight gain, presence of ketones in the urine, use of sick-day rules,
and any red-flag psychosocial conditions.
CPT Codes:
99242-99244 Office consultation, new or established patient - select CPT code based on
time with the patient and key components of care provided.
Postpartum follow-up
1/2 - 1 hour
Assessment at 6 to 8 weeks postpartum to determine Medical Nutrition Therapy based on
non-pregnant state, lactation needs, and other medical conditions requiring adjustment of the
diet. Insulin adjustments for non-pregnant state, blood glucose monitoring, risk reduction
counseling regarding weight control, exercise and follow-up testing for diabetes (if GDM).
Emphasis on appropriate contraception and family planning for future pregnancies and to
promote preconception planning.
Referral to other providers as needed.
CPT Codes:
99242-99244 Office consultation, new or established patient - select CPT code based on
time with the patient and key components of care provided.
CDAPP SWEET SUCCESS AFFILIATE
ON-LINE ANNUAL SURVEY
Please complete and return by email to the CDAPP Sweet Success Resource and
Training Center one week prior to your conference call.
use your TAB or ARROW keys to highlight/go to the next field
Affiliate or Satellite Name:
Affiliate or Satellite Number:
Date of Inception as CDAPP Sweet Success Affiliate or Satellite:
Have you been an Affiliate in the past?
YES
NO
Affiliate or Satellite Lead Staff:
Affiliate or Satellite Medical Director:
Affiliate or Satellite Address:
Email Address:
Affiliate or Satellite Telephone Number:
Fax Number:
Check the best way to contact Lead Staff*
Staff Name(s):
RN or RD
license #
phone
Expiration
date
email
Training
Name and Date
other
# of
hours
Voice Mail Number
&/or Email Address
*
Attach page listing additional staff as needed.
SITE SPECIFIC DATA This section reflects Annual data
Clients
Number
Diagnosis at first CDAPP Sweet Success visit
# Type 1 Diabetes
# Type 2 Diabetes
# GDM
Continuing clients from
prior calendar year
New clients this year
Total number of clients
How can the CDAPP Sweet Success Resource and Training Center help you?
Affiliate staff member(s) completing this form:
CDAPP Sweet Success Resource and Training Center team member(s) review
Revised on 12/06/2012
Date
Date