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Cdc Diabetes Prevention Program Reimbursement

The Y : Ymca's Diabetes Prevention Program

The Y : Ymca's Diabetes Prevention Program

More than 200 Ys across the country help thousands of people reduce their risk for developing type 2 diabetes with YMCAs Diabetes Prevention Program. This small-group program helps people with prediabetes eat healthier, increase their physical activityand lose weight, which can delay or even prevent the onset of type 2 diabetes. Diabetes is a chronic disease that causes blood sugar levels to rise higher than normal. Diabetes affects more than 29 million people. A condition calledprediabetesoccurs when blood sugar levels are higher than normal but not high enough for a type 2 diabetes diagnosis. More than 86 million Americans have prediabetes and are at risk of developing diabetes. Diabetes has no cure, but prediabetes can be reversed. Chances are you know at least one person with diabetes and probably more than one with prediabetes. To find out if you are at risk, take this quick test . Then share the test with friends and family. If you find out you or someone you know is at risk for developing diabetes, the YMCA's Diabetes Prevention Program can help. Find out if a Y near you runs the program . Continue reading >>

Medicare Diabetes Prevention Program Enrollment Is Now Open

Medicare Diabetes Prevention Program Enrollment Is Now Open

Medicare Diabetes Prevention Program Enrollment is Now Open by Darlene S. Davis , Amanda Makki , Macy L. Flinchum As of January 1, 2018, the Centers for Medicare & Medicaid Services (CMS) began enrolling suppliers in its new Medicare Diabetes Prevention Program (MDPP). If successfully enrolled prior to April 1, 2018, MDPP suppliers may begin furnishing and billing for services under the MDPP program as of that date. [1]The MDPP model is an expansion of CMSs Center for Medicare and Medicaid Innovation (CMMI) Diabetes Prevention Program (DPP) model tested under the authority of Section 1115A of the Social Security Act. CMS first introduced the MDPP expanded model in its Medicare Physician Fee Schedule (MPFS) final rule for Calendar Year (CY) 2017 (2017 Final Rule). [2]In the MPFS final rule for CY 2018 (2018 Final Rule), CMS finalized additional program guidance and implementation information, including implementing supplier standards and enrollment requirements and establishing payment rates. [3]Recently, CMS released the new enrollment application form [4]for MDPP suppliers and subregulatory guidance on the enrollment process. [5] In the United States, type 2 diabetes affects over 25 percent of individuals age 65 and over, and its prevalence is projected to double for all adults ages 18-79 by 2050 if current trends continue. [6]Given the substantial health care costs expended in treating diabetes and related comorbidities, the goal of the MDPP is to test a method of preventing the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes in hopes of decreasing the incidence rate of type 2 diabetes and ultimately cutting health care costs by creating a healthier population. MDPP seeks to prevent diabetes through a structured behavioral chan Continue reading >>

Work To Do Before Medicare's Diabetes Prevention Program Is Set In Place

Work To Do Before Medicare's Diabetes Prevention Program Is Set In Place

Work to Do Before Medicare's Diabetes Prevention Program Is Set in Place Nina C. Brown-Ashford, MPH, CHES, remembers when the Center for Medicare and Medicaid Innovation (CMMI) received the first field reports from the pilot of the National Diabetes Prevention Program (DPP) with the Y-USA. The results were so positive that another agency veteran said, I think there might be something here. That set in motion calls to CDCs Ann Albright, PhD, RD, the director of the Division of Diabetes Translation, and a process that would lead CMS actuary to certify that pilot participants saved Medicare $2650 a piece over 15 months. Ultimately, 83% of the participants would take part in at least 4 sessions, and the average weight loss was 9 pounds. Back in March 2016, it was official: DPP would go national in Medicare, come January 1, 2018. That felt really far away, said Brown-Ashford, now the acting director of the Division of Health Care Delivery at CMMI. On Saturday, she described Medicare DPP as starting on or after that January 1, 2018, target date. While no one is arguing the benefits DPP will ultimately offer, starting a government program from scratchwith features no one has ever used beforeis proving a daunting task. Brown-Ashford led off a symposium at the 77thScientific Sessions of the American Diabetes Association on success stories about the DPP, which has been shown in clinical trials to help those with prediabetes reduce their risk of progressing to type 2 diabetes by 58%. Recent evidence published in Diabetes Care from 4 years of experience with DPP found major progress and offer hints on improving the program. Medicare DPP will involve many firsts, Brown-Ashford said: CMS must create a brand-new class of nonclinical suppliers in the community coaches. It will be fash Continue reading >>

Medicare To Cover Diabetes Prevention Program!

Medicare To Cover Diabetes Prevention Program!

Medicare to Cover Diabetes Prevention Program! "Monumental news for the 51% of American seniors living with prediabetes." In a meaningful first for preventive care in the US, Medicare will now reimburse the Diabetes Prevention Program (DPP) , a proven educational program for those with prediabetes. Experts determined that the DPP not only is successful in decreasing participants risk for developing diabetes (through an average ~5% body weight loss), but also saves Medicare an average of $2,650 per person enrolled in the program for 15 months more than enough to cover the cost of the program (which can cost up to $ 430 out of pocket, without insurance). The proposal still needs to go through a public comment period, but it is likely to be adopted . Click here to find the full list of CDC-approved programs near you. The DPP is a CDC-approved program that provides participants with a combination of intense individual counseling and motivational support on effective diet, exercise, and behavior modification. It has proven effective in helping seniors lose an average of 5% of their body weight , enough to reduce their risk of diabetes by an average of 71%. Of the 86 million Americans with prediabetes, at least 22 million are people over the age of 65 (which translates to over 50% of seniors having prediabetes!). Research from the CDC demonstrates that, without intervention, up to one third of those with prediabetes will end up developing type 2 diabetes within five years. According to the official certification from CMS , Medicare beneficiaries will have to meet the following criteria in order to qualify for DPP: Impaired fasting glucose (fasting plasma glucose of 110 125 mg/dl) OR Impaired glucose tolerance (two-hour plasma glucose after Glucose Tolerance Test of 140 mg/dl Continue reading >>

Codes Display Text

Codes Display Text

(a)It is the intent of the Legislature that the department pursue policies and programs to assist Medi-Cal beneficiaries in preventing or delaying the onset of type 2 diabetes. (b)(1)The department shall establish the Diabetes Prevention Program (DPP) within the Medi-Cal fee-for-service and managed care delivery systems. (2)A Medi-Cal managed care plan shall make the DPP available to enrolled beneficiaries in accordance with this article. (c)In implementing the DPP, the department shall require that Medi-Cal providers offering DPP services comply with guidelines issued by the federal Centers for Disease Control and Prevention (CDC) and obtain CDC recognition in connection with the National Diabetes Prevention Program. (d)The DPP shall be an evidence-based, lifestyle change program designed to prevent or delay the onset of type 2 diabetes among individuals with prediabetes. (e)The DPP shall be made available to Medi-Cal beneficiaries no sooner than July 1, 2018. (f)A Medi-Cal provider may identify and recommend participation in the DPP to a beneficiary who meets all of the following requirements: (1)The beneficiary is at least 18 years of age. (2)As of the date of the provider recommendation, the beneficiary has a body mass index (BMI) of at least 25 if the beneficiary is not self-identified as Asian, or a BMI of at least 23 if the beneficiary is self-identified as Asian. (3)Within the 12-month period prior to the provider recommendation, the beneficiary has had one of the following: (A)A hemoglobin A1c test with a value between 5.7 and 6.4 percent. (B)A fasting plasma glucose of 110-125 mg/dL. (C)A two-hour plasma glucose of 140-199 mg/dL. (4)The beneficiary has no previous diagnosis of type 1 diabetes or type 2 diabetes, with the exception of gestational diabetes. (5) Continue reading >>

Medicare Diabetes Prevention Program (mdpp) Expanded Model

Medicare Diabetes Prevention Program (mdpp) Expanded Model

Background Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. We estimate that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes (estimates based on fee-for-service, non-dual eligible, over age 65 beneficiaries). Fortunately, type 2 diabetes can usually be delayed or prevented with health behavior changes. The Medicare Diabetes Prevention Program (MDPP) expanded model is a structured behavior change intervention that aims to prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. This model is an expansion of the Diabetes Prevention Program (DPP) model test, which was tested through the Center for Medicare and Medicaid Innovation’s Health Care Innovation Awards. The final rule establishing the expansion was finalized in the Calendar Year (CY) 2017 Medicare Physician Fee Schedule (PFS) final rule published in November 2016. On November 2, 2017, CMS issued the CY 2018 PFS final rule, which established policies related to the set of MDPP services, including beneficiary eligibility criteria, the MDPP payment structure, and supplier enrollment requirements and compliance standards aimed to enhance program integrity. The MDPP Expanded Model The Medicare Diabetes Prevention Program expanded model is a structured intervention with t Continue reading >>

The National Dpp Coverage Toolkit: Timely Tools For Payers Addressing Prediabetes

The National Dpp Coverage Toolkit: Timely Tools For Payers Addressing Prediabetes

The National DPP Coverage Toolkit: Timely Tools for Payers Addressing Prediabetes More than 86 million American adults have prediabetes. That number alone is astounding, but perhaps what is even more concerning is that 9 out of 10 people with prediabetes dont know they have it. Considering that, in the absence of any health intervention, 1530 percent of people with prediabetes will develop type 2 diabetes within five years, effective preventive measures are needed to mitigate a serious public health crisis. The Centers for Disease Control and Prevention (CDC) is proactively responding to this potential problem by developing and promoting the National Diabetes Prevention Program (National DPP) lifestyle change program. The National DPP Lifestyle Change Program The National DPP lifestyle change program is an evidence-based program that can be provided through an in-person classroom-like setting, a virtual platform, or a combined approach. To receive reimbursement, the site facilitating the program must obtain CDC recognition. A few states currently cover the program for Medicaid beneficiaries, several states cover the program for state employees, and many employers cover the program as an employee benefit. Medicare coverage of the program will become effective in 2018. As interest in covering the National DPP lifestyle change program has grown, so has the need for a tool that can help organizations navigate the potential complexities of covering the program. The result is the National DPP Coverage Toolkit. The National DPP Coverage Toolkit is a web-based resource developed in partnership by the National Association of Chronic Disease Directors (NACDD), Leavitt Partners, and the CDC. The online toolkit provides specific resources and information on important topics for pa Continue reading >>

Diabetes Prevention Programs Avert, Delay Disease Onset

Diabetes Prevention Programs Avert, Delay Disease Onset

Diabetes prevention programs avert, delay disease onset Diabetes is a devastating disease. In addition to the long-lasting health effects, such as blindness and cardiovascular disease, the total economic cost of diabetes is a whopping $ 245 billion a year , accounting for one out of every 10 American healthcare dollars spent, according to a 2013 study in Diabetes Care. These costs, driven by the mushrooming prevalence of type 2 diabetes, prompted the CDC to expand the evidence-based National Diabetes Prevention Program (DPP) to reach a large population. The program targets the estimated 86 million Americansone in every three adultswith prediabetes, up to 30% of whom will develop diabetes within five years without intervention. Engaging people with prediabetes to modify their behavior is challenging, but the National DPP demonstrates that efficient, effective programs can change the lives of people at risk. What are National Diabetes Prevention Programs (National DPPs)? National DPPs are programs that are recognized by CDC. They implement the intensive lifestyle change program that features a trained coach leading a group of people with prediabetes who meet regularly in person, online, or via telehealth during a 12-month period. While the lifestyle coach facilitates the CDC-approved curriculum and provides resources to help people set goals and overcome barriers, the vital ingredient is the camaraderie the meetings foster in a support-group environment. Participants who attend the program reduce their risk of development, or delay type 2 diabetes significantly. In 2012, six organizations were chosen to work in a cooperative agreement with the CDC to expand the National DPP using various models, with a goal of sustainability. The NIH randomized DPP studies found people w Continue reading >>

Questions & Support| Ndpp | Diabetes | Cdc

Questions & Support| Ndpp | Diabetes | Cdc

Many organizations are offering a CDC-recognized program. Based on their experiences, CDC has posted answers to frequently asked questions that address many of the challenges or uncertainties you might encounter. You may also be able to find organizations in your area that are willing to share lessons they learned along the way. CDC can provide technical assistance to help you deliver an effective program and solve challenges to achieve and maintain recognition status. Send your questions to [email protected] . Frequent Questions about Offering a Program What is the "CDC's Diabetes Prevention Recognition Program (DPRP) Standards and Operating Procedures" (Recognition Standards, for short)? A document that describes, in detail, all the requirements for organizations that are part of DPRP. All organizations must read and understand this document before applying for recognition. My organization is thinking of offering a CDC-recognized lifestyle change program in our community. What should we do first? Organizations are strongly encouraged to read the CDC Recognition Program Standards and Operating Procedures and complete the Capacity Assessment [PDF 58.4KB] before applying for recognition. If your organization does not have capacity at this time, you may want to support other sites in your area. What can organizations do if they feel that the cost of participating in a CDC-recognized lifestyle change program is too burdensome for participants? The cost for participation in a CDC-recognized lifestyle change program depends on a variety of things, including the host organizations funding/resources, ability to work with partners and garner reimbursement for services via private or public insurers, and whether the program is offered at a worksite as part of a benefits package t Continue reading >>

Community Providers May Struggle With Cms Rule On The Diabetes Prevention Program

Community Providers May Struggle With Cms Rule On The Diabetes Prevention Program

Community Providers May Struggle With CMS Rule on the Diabetes Prevention Program Contributor > Brenda Schmidt > > Published on: November 29, 2016 Community Providers May Struggle With CMS Rule on the Diabetes Prevention Program The proposal from CMS may make it difficult for groups that have been providing the DPP to take part in Medicare reimbursement. HHS Secretary Sylvia Burwell announced in March that the Diabetes Prevention Program (DPP) would be eligible for Medicare coverage, starting January 1, 2018. This new benefit was based on the documented savings and opportunity to prevent type 2 diabetes (T2D) among Medicare beneficiaries. CMS actuary certified that the Medicare DPP pilot program created an estimated $2650 return on investment per person over a 14-month time horizon. Based on the published program evidence, seniors who lose at least 5% of their body weight reduce their risk of developing T2D by 70%. It is especially significant that coverage for the National DPP marks that first time since the passage of the Affordable Care Act that Medicare coverage has been extended to a preventative health program. The DPP is primarily delivered in group sessions in a community setting, facilitated by a non-clinical lifestyle coach trained to deliver the Centers for Disease Control and Prevention (CDC) standardized curriculum. The program can also be delivered virtually via text message, telephone, digital apps, video chat, and other modalities by more than 40 digital platforms currently recognized by the CDC. While it is good news that the CMS is extending Medicare coverage for the DPP, there are key issues that must be resolved. For example, the CMS concerns about program integrity means that they are delaying decisions on several important aspects of the rule, inc Continue reading >>

Cms Must Ensure Seniors Have Access To Diabetes Prevention Resources

Cms Must Ensure Seniors Have Access To Diabetes Prevention Resources

The scourge of type 2 diabetes across the United States costs American taxpayers billions of dollars every single year. Diabetes and diabetes-related treatment is one of the biggest drivers of rising health care costs for every payer — with Medicare spending more on treating those with the disease every year. This is particularly true in rural America, as the prevalence of diabetes and coronary heart disease is approximately 17 and 39 percent higher in rural areas than urban areas. Policymakers from both sides of the aisle recognize this reality, and have embraced the challenge of confronting a preventable, but devastating, epidemic. Last month, for the first time in the agency’s history, the Centers for Medicare and Medicaid Services laid out proposed rules to reimburse providers to proactively prevent chronic disease by paying for the evidence-based Diabetes Prevention Program for eligible beneficiaries. Last year, the CMS Actuary certified that this program both improved quality of care and reduced costs for Medicare. But unfortunately, the proposed rule missed a huge opportunity to extend access to this benefit to the area most in need: rural America. In the July 13 rule, CMS proposed only making in-person DPP providers eligible for reimbursement, despite enormous evidence that virtual providers can achieve equal, or even better, results with senior populations. In addition, CMS’ sister agency, the Centers for Disease Control and Prevention, has been recognizing digital programs for more than two years while also collecting data demonstrating these programs’ effectiveness. By excluding virtual DPP from Medicare, CMS has tilted the scales in favor of seniors that reside in urban areas with easy access to brick and mortar programs; even urban and suburban seni Continue reading >>

Lessons From Launching The Diabetes Prevention Program In A Large Integrated Health Care Delivery System: A Case Study

Lessons From Launching The Diabetes Prevention Program In A Large Integrated Health Care Delivery System: A Case Study

Lessons from Launching the Diabetes Prevention Program in a Large Integrated Health Care Delivery System: A Case Study Colin D. Rehm , PhD, MPH,1,,2 Melinda E. Marquez , MPH, CHES,1 Elizabeth Spurrell-Huss , MPH, MSW,1 Nicole Hollingsworth , EdD, MCHES,1 and Amanda S. Parsons , MD, MBA 1Office of Community & Population Health, Montefiore Health System, Bronx, New York. 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. 1Office of Community & Population Health, Montefiore Health System, Bronx, New York. 3Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, New York. 1Office of Community & Population Health, Montefiore Health System, Bronx, New York. 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. 3Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, New York. Address correspondence to:, Amanda S. Parsons, MD, MBA, Office of Community & Population Health, Montefiore Health System, Bronx, NY 10467, E-mail:Email: [email protected] Author information Copyright and License information Disclaimer Copyright Colin D. Rehm et al 2017; Published by Mary Ann Liebert, Inc. This article is available under the Creative Commons License CC-BY-NC ( ). This license permits non-commercial use, distribution and reproduction in any medium, provided the original work is properly cited. Permission only needs to be obtained for commercial use and can be done via RightsLink. There is urgent need for health systems to prevent diabetes. To date, few health systems have implemented the evidence-based Diabetes Prevention Program (DPP), and the few that have mostly partnered with community-based organizations to implement t Continue reading >>

Diabetes Prevention Program Resource Center - American College Of Preventive Medicine

Diabetes Prevention Program Resource Center - American College Of Preventive Medicine

Diabetes Prevention Program Resource Center About the Program Research / ROI Patient Materials Referral Strategies Insurance Coverage Provider Reimbursement Events / Webinars ACPM recently began our second year of partnership with the Division of Diabetes Translation at CDC to increase physician awareness, screening and referral to the National Diabetes Prevention Program (National DPP). The CDC-led National DPP is a partnership of public/private organizations working collectively to establish, spread, and sustain an evidence-based lifestyle change program for people with prediabetes to prevent or delay onset of type 2 diabetes. The partners work to make it easier for people with prediabetes to participate in evidence-based, affordable, and high-quality lifestyle change programs to reduce their risk of type 2 diabetes and improve their overall health. The goal of ACPM's work with CDC is to increase physicians' and health care professionals' awareness of prediabetes as a serious health condition and to increase the number of physicians and health care professionals taking action to screen, test, and refer patients with prediabetes to CDC-recognized diabetes prevention programs (programs with pending or full recognition). The resource center is provided as a one stop resource to equip physicians and health care professionals planning to increase awareness, screening and referral within their practice. It contains materials from the Centers for Disease Control and Prevention, the American Medical Association, YMCA of the USA, Solera Health and other national partners. Continue reading >>

Cdcs Diabetes Prevention Program Questions And Answers #3

Cdcs Diabetes Prevention Program Questions And Answers #3

Q. Will Medicare pay for the program participants that are in the pending recognition status? A.Pending recognition status is the initial application process for CDC diabetes prevention program recognition (DPRP) for the NDPP. A program with pending recognition is not eligible for Medicare payments. Medicare will be requiring organizations to have Full CDC Diabetes Prevention Program Recognition to enroll as Medicare Suppliers. CMS is considering another category of recognition which would be addressed in future rule-making. Q. It was mentioned that NDPP will only be reimbursed from Medicare for face-to-face groups initially. Would a live, telephone group be considered face-to-face? A.No, telephonic delivery is not considered face-to-face. CMS will not pay for non-face-to-face delivery of the program in 2018. Future rule-making will address virtual delivery and payment. Q. How different is the CDC approved DPP from the American Diabetes Associations Diabetes Self-Management and Education Program? A.The National DPP and Diabetes Self-Management and Education (DSME) program are different programs altogether. The National DPP is intended to prevent the onset of type 2 diabetes in populations with prediabetes. DSME programs provide standardized education and training for populations already living with diabetes. DSME programs are recognized by the American Diabetes Association or accredited by the American Association of Diabetes Educators. Programs that deliver the National DPP are recognized/accredited by the CDC. DSME programs that also wish to deliver the National DPP must go through the process to become CDC-Recognized (full) and enroll as a Medicare Supplier to deliver the National DPP to Medicare beneficiaries with prediabetes. Q.Does one need to be a certified diab Continue reading >>

Medicare Diabetes Prevention Program

Medicare Diabetes Prevention Program

Beginning April 1, 2018 Medicare beneficiaries with prediabetes who also have elevated body mass indices ( 25 kg/m2 and 23 kg/m2 in Asian populations) have a new benefit with coverage for diabetes prevention services. The coverage is for a year of in-person structured health behavior change sessions (set of services) that use an approved curriculum from the Centers for Disease Control and Prevention. The services can only be provided by programs that are approved Medicare suppliers of the Medicare Diabetes Prevention Program (MDPP). Supplier enrollment began on January 1, 2018 to allow time for programs to complete the application process and prepare for providing services to beneficiaries on or after April 1, 2018. The MDPP provides opportunities for nutrition and dietetics practitioners to play an important role in diabetes prevention in the Medicare population in health care and community settings. There are various roles for nutrition and dietetics practitioners. The following pages are designed to help you understand the training requirements for MDPP lifestyle coaches, opportunities to integrate MDPP services into the continuum of care for diabetes and increase referrals for Medical Nutrition Therapy and other services, and requirements for becoming a Medicare supplier. Many private payers already cover diabetes prevention services. The payment methodology, billing codes, and requirements are different for the MDPP. Medicare will be using an Alternative Payment Model that is a performance-based payment methodology for the MDPP services. There are fifteen new G codes for the MDPP as well as attendance and weight loss benchmarks to earn maximum payments from the Centers for Medicare and Medicaid Services. The CDC created the National Diabetes Prevention Program bas Continue reading >>

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