Friday, June 7, 2019

Medicare Diabetes Prevention Program (MDPP)


Expanded Model Fact Sheet Overview of MDPP

The MDPP expanded model includes an evidence-based set of services aimed to help prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. MDPP services will be available to eligible beneficiaries nationwide beginning April 1, 2018 under a performance-based payment model through the CMS Innovation Center.

Questions about MDPP

What is covered through the model?

• Structured sessions with a coach, using a CDC-approved curriculum to provide training in dietary change, increased physical activity, and weight loss strategies

• 12 months of core sessions for beneficiaries with an indication of prediabetes, and an additional 12 months of ongoing maintenance sessions for participants who meet weight loss and attendance goals.

How does the model pay for MDPP services?

MDPP suppliers are paid performance-based payments through the CMS claims system. Medicare payments to suppliers will range, and can be up to $670 per beneficiary over
2 years, depending on beneficiaries’ attendance and weight loss.

What does this mean for beneficiaries?
Beginning April 1, 2018, eligible beneficiaries have coverage of MDPP services with no costsharing through Medicare-enrolled MDPP suppliers.
Eligible beneficiaries are those who:
• Are enrolled in Medicare Part B
• Have a body mass index (BMI) of at least 25, or at least 23 if self-identified as Asian
• Meet 1 of the following 3 blood test requirements within the 12 months of the first core session:
    ? A hemoglobin A1c test with a value between 5.7 and 6.4% , or
    ? A fasting plasma glucose of 110-125 mg/dL, or
    ? A 2-hour plasma glucose of 140-199 mg/dL (oral glucose tolerance test)
• Have no previous diagnosis of type 1 or type 2 diabetes (other than gestational diabetes)
• Do not have end-stage renal disease (ESRD)

What does this mean for providers?

Although a referral from a physician is not required for beneficiaries to participate in MDPP services, clinicians have an important role to play in helping beneficiaries understand their risk of diabetes and their treatment options. This is particularly important because only 14% of adults aged 65 and older with prediabetes are aware of their condition. Clinicians may help Medicare patients obtain the blood tests they need to become aware of their risk and recommend they
participate in MDPP services.

What does this mean for organizations that wish to deliver MDPP services?

Organizations who wish to furnish MDPP services to beneficiaries and bill Medicare for those services must enroll in Medicare as an MDPP supplier.

To enroll as an MDPP supplier, organizations must:
• Have MDPP preliminary recognition or full CDC DPRP recognition
• Have an active and valid tax-identification number (TIN) or national provider identifier (NPI)
• Pass enrollment screening at the high categorical risk level
• On the MDPP enrollment application, submit a list of MDPP coaches who will lead sessions,including full name, date of birth, social security number (SSN), and active and valid NPI and coach eligibility end date (if applicable)
• Meet MDPP supplier standards and requirements, and other requirements of existing Medicare providers or suppliers
• Revalidate its enrollment every 5 years

Key Dates
• January 2018– MDPP supplier enrollment begins
• April 2018– Enrolled MDPP suppliers may begin furnishing services and billing Medicare

Centers for Disease Control and Prevention.
CDC twenty four seven. Saving Lives, Protecting People

National Diabetes Prevention Program
CDC-recognized lifestyle change programs are based on years of research showing that a year-long, structured lifestyle change intervention reduced the incidence of diabetes by 58% among adults with prediabetes and by 71% among those aged 60 years or older. The same study showed a 31% reduction with metformin compared with placebo. The researchers concluded that the lifestyle intervention was significantly more effective than metformin.

And the results last. Even after 10 years, people who completed a diabetes prevention lifestyle change program had a 34% lower rate of type 2 diabetes.

Participating in a program to lose weight through healthy eating and increased physical activity can also reduce the risk of heart attack and stroke.

Quality Standard

To ensure high-quality interventions, CDC only recognizes lifestyle change programs that meet evidence-based standards and show they can achieve results. These standards include:

• Following a CDC-approved curriculum
• Facilitation by a trained lifestyle coach
• Making regular data submission (according to the timeline dictated in the current DPRP Standards) to show that the program is having an impact.

Serious & Common

More than 84 million US adults—that’s 1 in 3—have prediabetes. With prediabetes, blood sugar is higher than normal but not high enough yet to be diagnosed as diabetes. People with prediabetes are at high risk for type 2 diabetes (the most common type of diabetes), heart disease, and stroke.

In the last 20 years, the number of adults diagnosed with diabetes has more than tripled as the US population has aged and become more overweight. Now more than 30 million Americans have diabetes, which increases their risk for a long list of serious health problems, including:

•Heart attack
•Stroke
•Blindness
•Kidney failure
•Loss of toes, feet, or legs
The good news: the CDC-led National Diabetes Prevention Program’s lifestyle change program can help people with prediabetes prevent or delay type 2 diabetes and other serious health problems and improve their overall health. It’s scientifically proven, and it works.

Diabetes Is Expensive
Diabetes has an enormous economic impact on millions of individuals and their families, on workplaces, and on the US health care system.

In 2017, the total estimated cost of diagnosed diabetes was $327 billion ($237 billion in direct medical costs and $90 billion in lost productivity), up 26% over a 5-year period.
About 1 in 4 health care dollars is spent on people with diagnosed diabetes.
Medical expenses for people diagnosed with diabetes—$16,750 annually on average—are about 2.3 times higher than for people without diabetes.

The Time To Act Is Now
Don’t let the “pre” in prediabetes fool you—prediabetes is a serious health condition that can develop into even more serious health conditions.

Program Eligibility

CDC-recognized lifestyle change programs are designed for patients who have prediabetes and are at high risk for developing type 2 diabetes.

Follow the guidelines below to know which patients are eligible for the program.
Which Patients to Refer
To be eligible for referral to a CDC-recognized lifestyle change program, patients must meet the following requirements:

•Be at least 18 years old and
•Be overweight (body mass index =25; =23 if Asian) and
•Have no previous diagnosis of type 1 or type 2 diabetes and
•Have a blood test result in the prediabetes range within the past year:
    •Hemoglobin A1C: 5.7%–6.4% or
    •Fasting plasma glucose: 100–125 mg/dL or
    •Two-hour plasma glucose (after a 75 gm glucose load): 140–199 mg/dL or
•Be previously diagnosed with gestational diabetes


Prediabetes can be diagnosed via oral glucose tolerance tests, fasting blood glucose tests, or an A1C test. Blood-based testing is the most accurate way to determine if a patient has prediabetes.

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