Expanded Medicare Diabetes Prevention Program Begins April 1: What Physicians Should Know
Expanded Medicare Diabetes Prevention Program Begins April 1: What Physicians Should Know Starting April 1, 2018, eligible Medicare beneficiaries have coverage of Medicare Diabetes Prevention Program (MDPP) services through approved MDPP suppliers. There is no beneficiary cost-sharing associated with this coverage. The MDPP expanded model covers structured sessions with a coach, using a Centers for Disease Control and Prevention (CDC) approved curriculum on dietary change, increased physical activity, and weight loss strategies. Medicare Part B beneficiaries diagnosed with prediabetes can access 12 months of core sessions. If goals of at least 5 percent weight loss are met, patients can then access an additional 12 months of maintenance sessions. Reimbursement for MDPP suppliers will range depending upon beneficiaries attendance and weight loss. Claims payments can reach a maximum of $670 over two years. Which Medicare beneficiaries are eligible for the program? The Centers for Medicare and Medicaid Services (CMS) defines MDPP-eligible beneficiaries as those who: Have a body mass index (BMI) of at least 25, or at least 23 if self-identified as Asian Meet one of the following three blood test requirements within 12 months of the first core session: A hemoglobin A1c test with a value between 5.7 and 6.4 percent, 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, with the exception of gestational diabetes Do not have end-stage renal disease (ESRD) Enrollment for MDPP began on Jan. 1, 2018, and applications will be accepted on a rolling basis at any time. Organizations (including physician groups) can apply to furnish MDPP services if they meet CMS Continue reading >>
Medicare Diabetes Prevention Program Enrollment
Medicare Diabetes Prevention Program Enrollment Medicare Diabetes Prevention Program Enrollment On November 2, 2017, the Centers for Medicare & Medicaid Services issued the Calendar Year (CY) 2018 Physician Fee Schedule (PFS) final rule, which finalizes policies to implement the Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018. The expanded model is a structured intervention with the goal of preventing progression of type II diabetes in individuals with an indication of pre-diabetes. The CY 2018 PFS includes the MDPP payment structure as well as enrollment requirements and supplier compliance standards. The effective date for furnishing services is April 1, 2018. MDPP suppliers may begin enrolling on January 1, 2018, through a new MDPP-specific enrollment application, which will be available prior to January 1, 2018. Screening individuals that will be furnishing the MDPP services will be identified as coaches on the MDPP-specific form. Suppliers must meet and remain in compliance with several standards as a condition of initial and ongoing enrollment as a Medicare Supplier, including but not limited to: Suppliers may not be terminated from Medicaid Suppliers may not deny access to MDPP services, except in certain circumstances Suppliers must respond to beneficiary complaints reasonably and timely Submit evaluation crosswalk file upon request Continue reading >>
Why Mainers Are Taking Action
Diabetes in Maine is a problem 32,264 (3%) of Mainers have diabetes but don’t know it. Diabetes in Maine tripled between 1995 and 2010. Diabetes increases your risk of serious health problems Diabetes is the 7th leading cause of death in Maine. Persons with diabetes are more likely to die of heart disease or have a stroke. 6 out of 10 non-traumatic lower limb amputations in Maine are due to diabetes. Diabetes costs Maine families too much People with diabetes have twice the medical costs than those without. People with diabetes spend about $13,700 per year on medical costs, $7,900 of which is related to their diabetes. Diabetes is preventable 1 in 3 adults have pre-diabetes. Most don’t know it. Without lifestyle changes, 15%-30% will develop Type 2 diabetes within 5 years. NDPP works to prevent diabetes NDPP is proven to help people with pre-diabetes make lasting lifestyle changes that decrease their risk of getting diabetes. It was developed and researched by the US Centers for Disease Control and Prevention. NDPP is offered by worksites, hospitals, health centers and community organizations in nearly every county in Maine. The program provides one year of support in small groups led by trained lifestyle coaches. Action Steps For Mainers 1. Find out more about diabetes Read the fact sheet about Diabetes in Maine to learn more about Type 1 and Type 2 diabetes. Visit the US CDC National Diabetes Prevention Program website. 2. Assess your risk Talk to your doctor to see if you have diabetes or pre-diabetes. 3. Find out more about NDPP Ask your employer about NDPP in Maine. Call your health insurance company to find out if NDPP is part of your plan. Use this site to find a diabetes prevention program and lifestyle coach in your area. 4. Participate in NDPP Attend NDPP Continue reading >>
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 >>
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Cms Releases Final Rule For Medicare Physician Fee Schedule
CMS Releases Final Rule for Medicare Physician Fee Schedule The updated Medicare Physician Fee Schedule ruling will bring more focus to diabetes prevention and mental health needs. -Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that updates a number of reimbursement policies and rates under the Medicare Physician Fee Schedule (PFS), a CMS press release states . The new payment policies will go into effect on January 1, 2017. The areas in which the new Medicare Physician Fee Schedule updates will affect the healthcare industry include treating patients with mental or behavioral health needs, multiple chronic conditions, or cognitive impairment issues. In particular, the changes to the Medicare Physician Fee Schedule include greater payment accuracy in terms of care management and primary care services. The Physician Fee Schedule includes paying for services like doctor visits, surgeries, therapies, preventive care, and diagnostic testing. Along with the standard primary care doctor, specialists such as physical therapists, diagnosticians, physician assistants, and nurse practitioners are paid under the Medicare Physician Fee Schedule system. The type of advances the final ruling will have include new codes for both chronic care and transitional care management in order to bolster reimbursement accuracy. Also, separate payments will be made for Current Procedural Terminology (CPT) codes. CMS Comprehensive Primary Care Program Gained $57M in Savings One major aspect of the final ruling on Medicare Physician Fee Schedule includes the development of the Medicare Diabetes Prevention Program expanded model. The first expansion of the Medicare Diabetes Program was first announced in early 2016, according to a CMS fact sheet . The program i Continue reading >>
Diabetes Action Kit
Since 2002, the prevalence of diabetes has increased by nearly 50 percent among New York City adults. Recent reports indicate that 740,000 New Yorkers have diabetes and an additional 1.3 million have prediabetes, with the burden of disease falling disproportionately on minority communities of color. Of those living with prediabetes, an estimated nine out of 10 people are unaware of their condition. As a health care provider, you play a crucial role in helping your patients prevent or delay the onset of type 2 diabetes. The clinical tools, provider resources, and patient education materials in this Diabetes Action Kit will support and amplify your efforts to help patients with prediabetes and diabetes. Provider Resources Letter from the Health Commissioner (PDF) National Diabetes Prevention Program (NDPP) and Diabetes Self-Management Program (DSMP) Referral (PDF) Evidence Synopsis (PDF) Clinical Tools Healthy Eating Active Living Rx Pad (PDF) Other languages: [Español] Pre-Diabetes/Diabetes Coaching Scripts (PDF) Pre-Diabetes/Diabetes Treatment Guide (PDF) My Plate Planner (PDF) Other languages: [Español] Diabetes Checkbook (PDF) Other languages: [Español] [Русский] [中文] Medication List (PDF) Other languages: [Español] Patient Education Materials National Diabetes Prevention Program (NDPP) Fact Sheet (PDF) Other languages: [Español] Diabetes Self-Management Program (DSMP) Fact Sheet (PDF) Other languages: [Español] Guide to Healthy Eating & Active Living in NYC (PDF) Other languages: [Español] [中文] [Русский] Lifestyle Program Easel (PDF) Lifestyle Program Palm Card (PDF) Other languages: [Español] Continue reading >>
Diabetes Prevention
Prediabetes is a health condition in which blood glucose (sugar) level is higher than normal, but not high enough to be diagnosed as type 2 diabetes. According to the Centers for Disease Control and Prevention (CDC), people with prediabetes are more likely to develop diabetes within 5 years, and more likely to have a heart attack or stroke. Lifestyle changes such as eating healthier (e.g., eating more fruits and vegetables) and being physically active at least 150 minutes per week are proven to help reduce these risks. A major challenge in preventing diabetes is lack of public awareness. More than 1 in 3 adults in the United States have prediabetes, but 9 out of 10 people dont know it. Locally, the numbers are significantly higher. In San Diego, an estimated half of adult San Diegans are on the path to diabetes. What is the National Diabetes Prevention Program? The CDC-led National Diabetes Prevention Program (National DPP) is an evidence-based lifestyle change program for preventing type 2 diabetes that translates research into real-life disease prevention strategies. It proves that eating healthier, increasing physical activity, losing a small amount of weight, and managing stress, can prevent or delay type 2 diabetes by 58 percent. Developing support for National DPPs encourages collaboration among our regions community-based organizations, employers, insurers, health care professionals, government, academic researchers, and other stakeholders to prevent or delay the onset of type 2 diabetes. National Diabetes Prevention Program (National DPP) in San Diego The County of San Diego Health and Human Services Divisions of Public Health Services (PHS) and Aging & Independence Services (AIS) began offering the National DPP in San Diego through the Healthy Works: Preventio Continue reading >>
Questions & Answers About The Diabetes Prevention Program Outcomes Study
Questions & Answers about the Diabetes Prevention Program Outcomes Study Questions & Answers about the Diabetes Prevention Program Outcomes Study Questions & Answers about the Diabetes Prevention Program Outcomes Study What is the Diabetes Prevention Program (DPP)? The DPP was a randomized, controlled clinical trial that determined if certain interventions could prevent or delay type 2 diabetes in adults at high risk for developing the disease. The multicenter study enrolled 3,234 overweight participants with blood glucose levels that were higher than normal but not yet in the diabetic range. Forty-five percent of participants were from minority groups disproportionately affected by type 2 diabetes: African Americans, Hispanic Americans, Asian Americans and Pacific Islanders, and American Indians. The trial also recruited other groups at higher risk for type 2 diabetes, including individuals age 60 and older, women with a history of gestational diabetes, and people who have a first-degree relative with type 2 diabetes. What interventions were tested in the DPP? Participants were randomly assigned to one of the following approaches: Intensive lifestyle changes with the aim of reducing weight by 7 percent through a low-fat diet and increased physical activity. Participants were asked to maintain physical activity at least 150 minutes a week with moderate exercise, such as walking or biking. Standard advice on diet and exercise plus treatment with the drug metformin (850 mg twice a day), approved in 1995 to treat type 2 diabetes. Standard advice on diet and exercise plus placebo pills in place of metformin. A fourth arm of the study, treatment with the drug troglitazone (Rezulin) combined with standard diet and exercise recommendations, was discontinued in June 1998 due t Continue reading >>
National Diabetes Prevention Program :: Reimbursement/advocacy - National Association Of Chronic Disease Directors
CDC-Recognized Lifestyle Change Programs for Diabetes Prevention-4 States with Coverage for State Employees Attaining Health benefit coverage of CDC-Recognized Lifestyle Change Programs for state employees is an enormous success in the scaling of the National DPP and can be a significant motivator for additional employers and insurers to offer this benefit. This document provides details on the experiences of four State Health Departments from start to finish on achieving coverage for state employees. For a current list of states with coverage, view the NACDD webpage Halt Diabetes . A new Category III code, effective January 1, 2016, will be used to report the services provided for The National Diabetes Prevention Program. This article provides an overview of The National Diabetes Prevention program, and reviews the rationale for the creation of the new Category III code 0430T. NACDDs National DPP and Medicaid project is intended to demonstrate and evaluate the process for Medicaid coverage of the National DPP, analyze cost effectiveness of different coverage models, translate and communicate the potential for success within other state Medicaid integrated care organizations (as applicable), and work with the CDC to evaluate different engagement strategies for Medicaid beneficiaries in the National DPP. Promoting the National Diabetes Prevention Program As a Covered Benefit for State Employees This document describes the recent experiences of three statesKentucky, Minnesota, and Washingtonwhose health departments have collaborated with state employee benefit agencies, health plans, CDC-recognized diabetes prevention programs, and other partners to make the benefits of the National DPP more available to state employees and their families. Continue reading >>
Medicare Diabetes Prevention Program: Webinar And Comment Period
Medicare Diabetes Prevention Program: Webinar and Comment Period Medicare Diabetes Prevention Program: Webinar and Comment Period On July 7, 2016, the Centers for Medicare and Medicaid Services (CMS) announced a proposal to expand the Diabetes Prevention Program to Medicare beneficiaries beginning on January 1, 2018. The Diabetes Prevention Program is a structured lifestyle intervention that includes dietary coaching, lifestyle intervention, and moderate physical activity, all with the goal of preventing the onset of diabetes in individuals who are pre-diabetic. The Center for Medicare & Medicaid Innovation (CMS Innovation Center) will host a webinar to discuss various aspects of the Medicare Diabetes Prevention Program proposal on Tuesday, August 9, 2016 from 12:001:00pm EDT. Registration for this webinar is now open. CMS will accept comments on the proposed rule until September 6, 2016, and will respond to comments in a final rule. The proposed rule can be found on the Federal Register . The clinical intervention consists of 16 intensive core sessions of a curriculum in a group-based, classroom-style setting that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control. After the 16 core sessions, less intensive monthly follow-up meetings help ensure that the participants maintain healthy behaviors. The primary goal of the intervention is at least 5% average weight loss among participants. To learn more about these efforts to support and improve access to primary care please review the fact sheet , press release , or CMS blog post . Continue reading >>
Diabetes - Oklahoma State Department Of Health
Adults (Click on "Adults" to see complete Fact Sheet.) In 2014, about 351,880 Oklahomans 18 years and older were diagnosed with diabetes. American Indians and African American adults have the highest percentage of diabetes In 2014 nearly one in every four seniors was diagnosed with diabetes The percent of the adult population with diabetes is higher than in the US The death rate for diabetes is higher than in the US The Center for the Advancement of Wellness is funded through the Centers for Disease Control and Prevention. Funding mandates require a population based, public health approach.This includes public health prevention and control strategies.These strategies include designing, implementing, and evaluating access to and quality of care. Accredited/Certified Diabetes Self-Management Education Programs Registry of Recognized Programs (CDC): The national registry of recognized diabetes prevention programs lists contact information for programs that offer type 2 diabetes prevention programs in communities across the United States. New Beginnings: A Discussion Guide for Living Well with Diabetes : New Beginnings: A Discussion Guide for Living Well with Diabetes is an on-line resource that uses stories about African Americans with diabetes to help group leaders lead discussions about the emotional side of living with diabetes, and help people with diabetes identify family and social support needs and develop goal setting, positive coping and problem solving skills. New Beginnings can be used to supplement diabetes self-management education sessions and in diabetes support groups. Continue reading >>
Ymca Diabetes Prevention Program - Measurable Progress, Unlimited Support
YMCA Diabetes Prevention Program - Measurable Progress, Unlimited Support The YMCA's Diabetes Prevention Program helps adults at high risk of developing type 2 diabetes reduce their risk for developing the disease by taking steps that will improve their overall health and well-being. Research by the National Institutes of Health has shown that programs like the YMCA's Diabetes Prevention Program can reduce the number of new cases of Type 2 diabetes by 58%, and 71% in adults over the age of 60. - 16 weekly sessions, 3 bi-weekly sessions, 6 monthly sessions - Can be offered in any community setting Learn about healthier eating & increasing physical activity to reduce risk Increase physical activity to 150 minutes per week At risk for or have been diagnosed with PREDIABETES - Via a blood test with one of the following results: + Fasting plasma glucose between 100 - 125 mg/dL + 2-hour plasma glucose between 140 - 199 mg/dL - Or a previous diagnosis of gestational diabetes - If a blood test is not available, a qualifying risk score based on a combination of risk The Financial Impact of Diabetes on the Workforce is Staggering. The Facts: In 2012, the American Diabetes Association reported that the total medical costs and lost work and wages for people diagnosed with diabetes is $245 billion. Direct medical costs come to $176 billion and indirect costs, such as disability, loss of productivity, and premature death, equal $69 billion. These costs rose from $174 billion in 2007. The Diabetes Risk: These costs could easily grow because 1 out of 4 Americans do not know they have the disease and 9 out of 10 have no idea they are at risk for the disease. 29.1 million Americans suffer from diabetes: 21 million are diagnosed and 8.1 million are undiagnosed. Another 86 million America Continue reading >>
Enrollment Is Open For Medicare Diabetes Prevention Program Suppliers
Enrollment is Open for Medicare Diabetes Prevention Program Suppliers MDPP supplier enrollment has now begun for eligible organizations as of January 1, 2018, as a result of the publication of the Medicare Diabetes Prevention Program (MDPP) Final Rule . MDPP supplier applications can be accepted at any time. Delivery of and billing for MDPP services will begin April 1, 2018. There are two ways you can enroll in Medicare as an MDPP supplier: you can fill out and submit your enrollment application online using the Provider Enrollment, Chain and Ownership System (PECOS), or you can submit a paper enrollment application to a Medicare Administrative Contractor. The MDPP Supplier Enrollment Application (paper form) is now available online through CMS.gov here . This application can also be accessed and submitted online through PECOS . If your organization currently meets the requirements for enrolling as an MDPP supplier, including recognition and additional supplier standards, follow the steps below to begin the MDPP enrollment process: Review the MDPP Orientation Roadmap to understand the MDPP supplier journey For a more detailed introduction, watch the MDPP Orientation Webinar to gain a better understanding of MDPP - including requirements to enroll as a MDPP supplier, furnish MDPP services, and submit claims (please note registration is required to view the webinar) Continue reading >>
Diabetes Prevention Program (dpp)
If you are at-risk for diabetes or have prediabetes, you can take steps to reverse it. The Diabetes Prevention Program is an evidence-based program that can help you make lifestyle changes to greatly reduce your risk for or delay the onset of diabetes. The Diabetes Prevention Program has locations throughout Massachusetts. Find out if there is a program site near you. You’ll learn about how to eat healthier, how to add physical activity into your day, and how to manage stress. Groups of 8 to 15 people start the program at the same time. The groups are led by a trained Lifestyle Coach who helps and motivates you to make lifestyle changes that are right for you. DPP takes one year to complete. The first six months you’ll meet once a week to get started. Then for the next six months you meet one time each month to stay on track. Watch the video below on how DPP has made a difference in people’s lives. Who is Eligible for DPP? To participate, individuals must meet be: 18 years or older Overweight or obese In addition individuals must meet one of the three following criteria: Have been diagnosed with prediabetes (Fasting Blood Glucose 100-124 mg/dL, Hemoglobin A1C 5.7-6.4%, Oral Glucose Tolerance Test 140-199 mg/dL) Previously diagnosed with gestational diabetes Established risk factors for developing type 2 diabetes (use ADA Risk Test) if blood test not available Does the Diabetes Prevention Program work? The program is based on randomized-control trial showing that changes in lifestyle reduced type 2 diabetes risk among participants by 58% (70% for those over the age of 60). The two lifestyle changes that were studied were: Losing 7% of bodyweight (about 15 lbs. if you weigh 200 lbs.) Exercising at least 150 minutes a week (about 30 minutes, five days a week) People Continue reading >>
Diabetes Prevention Program (dpp)
On July 10, 2017, Governor Brown signed Senate Bill 97 to require the Department of Health Care Services (DHCS) to establish the Diabetes Prevention Program (DPP) as a Medi-Cal benefit within the fee-for-service (FFS)and managed care delivery systems.The DPP is an evidence-based, lifestyle change program designed to assist Medi-Cal beneficiaries diagnosed with prediabetes in preventing or delaying the onset of type 2 diabetes. DPP services are provided through trained peer coaches who use a Centers for Disease Control and Prevention (CDC)-approved curriculum. The DPP core benefit lasts one year, and consists of sixteen sessions over the first six months, and at least one session per month for the next six months, for a total of twenty-two sessions. Additional less intensive, ongoing maintenance sessions are also provided for eligible beneficiaries who achieve and maintain a required minimum weight loss of five percent from the first core session. Medi-Cal providers can recommend participation in the DPP to eligible Medi-Cal beneficiaries who meet all of the following requirements: The beneficiary is at least 18 years of age. As of the date of the provider recommendation, the beneficiary has a body mass index (BMI) of at least 25 if the beneficiary does not self-identify as Asian, or a BMI of at least 23 if the beneficiary self-identifies as Asian. Within the 12-month period prior to the provider recommendation, the beneficiary has had one of the following: A hemoglobin A1c test with a value between 5.7 and 6.7%. A fasting plasma glucose of 110-125 mg/dL. A two-hour plasma glucose of 140-199 mg/dL. The beneficiary has no previous diagnosis of type 1 or type 2 diabetes, excluding gestational diabetes. The beneficiary does not have end-stage renal disease. If you have any Continue reading >>
