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Medicare Diabetes Prevention Program Final Rule

Cms Finalizes Expanded Diabetes Prevention Program

Cms Finalizes Expanded Diabetes Prevention Program

CMS Finalizes Expanded Diabetes Prevention Program In its just-released final rule for the 2018 physician fee schedule (PFS), the Centers for Medicare & Medicaid Services (CMS) issued detailed regulations for the expanded model of the Medicare Diabetes Prevention Program (MDPP). Under this expanded model, which builds on an earlier test of MDPP and was announced in 2016, CMS will add MDPP as a covered benefit for Medicare beneficiaries who meet certain criteria, starting on April 1, 2018. MDPP is designed to supply coaching services to prediabetic patients to help them lose weight and avoid developing type 2 diabetes. Community health workers and health professionals will supply these services in community and healthcare settings. "The sessions provide practical training in long-term dietary change, increased physical activity, and problem-solving strategies for overcoming challenges to maintaining weight loss and a healthy lifestyle," the final rule said. The set of MDPP services includes core sessions (first 6 months), core maintenance sessions (second 6 months), and ongoing maintenance sessions (second year). Sixteen weekly sessions must be completed within the first 6 months, when the likelihood of losing weight is greatest. A key goal of MDPP is for beneficiaries to reduce their weight by at least 5% from baseline. They must achieve that goal by the end of the first year to be eligible for ongoing maintenance sessions in the second year. In the 2018 PFS proposed rule, MDPP services would have been offered for up to 3 years, including 2 years of ongoing maintenance. The final rule settled on a total of 2 years. Patients are eligible for MDPP only once in their lives. CMS said it believes that the one-time benefit will be more likely to motivate people than allowing Continue reading >>

Medicare Diabetes Prevention Program - Centers For Medicare & Medicaid Services

Medicare Diabetes Prevention Program - Centers For Medicare & Medicaid Services

Registration: Visit the MLN Event Registration website. Clarification [PDF, 192KB] The CY 2018 Medicare Physician Fee Schedule final rule includes the expansion of the Medicare Diabetes Prevention Program (MDPP) Model starting in 2018. During this call, CMS experts provide a high-level overview of the finalized policies. A question and answer session follows the presentation. The MDPP expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of pre-diabetes. Participants should review the final rule prior to the call. Target Audience:Current Centers for Disease Control and Prevention (CDC) recognized Diabetes Prevention Program organizations; organizations interested in becoming MDPP suppliers, including existing Medicare providers/suppliers, community organizations, non-for-profits; associations, and advocacy groups focused on seniors or diabetes; and other interested stakeholders, including health plans, primary care/internal medicine specialties. For More Information: Visit the MDPP Expanded Model webpage. 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 >>

Washington Association Of Community & Migrant Health Centers - Medicare Diabetes Prevention Program Model Expansion Call

Washington Association Of Community & Migrant Health Centers - Medicare Diabetes Prevention Program Model Expansion Call

Medicare Diabetes Prevention Program Model Expansion Call The CY 2018 Medicare Physician Fee Schedule final rule includes the expansion of the Medicare Diabetes Prevention Program (MDPP) Model starting in 2018. During this call, CMS experts provide a high-level overview of the finalized policies. A question and answer session follows the presentation. The MDPP expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of pre-diabetes. Participants should review the final rule prior to the call. Current Centers for Disease Control and Prevention (CDC) recognized Diabetes Prevention Program organizations; organizations interested in becoming MDPP suppliers, including existing Medicare providers/suppliers, community organizations, non-for-profits; associations, and advocacy groups focused on seniors or diabetes; and other interested stakeholders, including health plans, primary care/internal medicine specialties. Continue reading >>

Dietitian Course: Medicare Diabetes Prevention Program Model Expansion: Overview Of Final Rule In Cy 2018

Dietitian Course: Medicare Diabetes Prevention Program Model Expansion: Overview Of Final Rule In Cy 2018

MEDICARE DIABETES PREVENTION PROGRAM MODEL EXPANSION: OVERVIEW OF FINAL RULE IN CY 2018 This jammed-packed and detailed presentation is exactly what diabetes healthcare professionals and organizations need to successfully obtain reimbursement for the brand new Medicare Diabetes Prevention Program (MDPP) benefit, starting April 1, 2018. The most current coverage guidelines are outlined....in a very straightforward and easy-to-understand manner...with special emphasis on those that create the most confusion: the required structure of the MDPP in the core, core maintenance and on-going maintenance intervals in the first and second years; beneficiary entitlement and lab eligibility; supplier eligibility to furnish and bill for the benefit; lifestyle coach requirements; the 15 new "bundled" procedure codes; the CDC Diabetes Prevention Recognition Program (DPRP) requirements and the new CMS Interim Recognition requirements for organizations to enroll in Medicare as MDPP suppliers; and the MDPP payment rates. Organizations who are offer the MDPP now are allowed to enroll in Medicare Part B, effective 1-1-18 (if select criteria are met), so now is the right time to attend this webinar! The National Diabetes Prevention Program (National DPP) has shown an impressive 4.2% mean weight loss achievement in a large-scale study. CMS projects that the brand new Medicare DPP (MDPP) Expanded Model will save $182 million over 10 years. Beginning April 1, 2018 Medicare beneficiaries with prediabetes who also have elevated BMI and a lab value validating a diagnosis of prediabetes will have a new benefit with coverage for diabetes prevention services. The coverage is for 1 year of in-person structured health behavior change group sessions that use an approved curriculum from the Centers for Continue reading >>

Cms Announces Final Rule For Launching Medicare Diabetes Prevention Program Expansion

Cms Announces Final Rule For Launching Medicare Diabetes Prevention Program Expansion

On November 2 the Centers for Medicare & Medicaid Services (CMS) issued the 2018 Physician Fee Schedule final rule, which finalizes policies to implement the Medicare Diabetes Prevention Program expanded model starting in 2018. This expanded model will allow Medicare beneficiaries to access evidence-based diabetes prevention services, with the goal of a lower rate of progression to type 2 diabetes, improved health and reduced costs. The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of prediabetes. The clinical intervention consists of a minimum of 16 intensive core sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum furnished over six months 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 completing the core sessions, less intensive follow-up meetings furnished monthly will help ensure that the participants maintain healthy behaviors. The primary goal of the expanded model is at least 5 percent weight loss by participants. The final rule, published in November 2016, established the expansion and aspects of the expanded model policy framework. The 2018 final rule finalizes additional policies necessary for suppliers to begin providing the expanded model nationally in 2018, including payment structure, as well as additional supplier enrollment requirements and supplier compliance standards aimed to enhance program integrity. Services provided under the expanded model would largely be furnished in person. Continue reading >>

National Dpp

National Dpp

The proposed beginning date is April 1, 2018, Medicare Part B insured participants will be able to attend the National DPP lifestyle change classes as a preventive benefit without a co-pay. Medicare Diabetes Prevention Program (MDPP) On March 23, 2016, the Department of Health and Human Services (HHS) announced that the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary (OACT) certified that the National Diabetes Prevention Program (National DPP) lifestyle change program would reduce net-Medicare spending. It reviewed results from the first two years of the YMCA of the USA (Y-USA) Health Care Innovation Award implementation, the original DPP randomized clinical trial, and a subset of National DPP lifestyle change programs recognized by the CDC. Visit www.nationaldppcoveragetoolkit.org/medicare-advantage/mdpp-final-rule for details. The Centers for Medicare and Medicaid (CMS) is in the process of setting up a support center to assist organizations that want to become MDPP suppliers. CMS will have a webinar, web site with tip sheets and more. The Medicare DPP rule wont be finalized until November, therefore, CMS cant announce these resources until then. More on this soon. MDPP services will be paid for through a performance-based payment methodology (final payment amounts announced soon) A maximum of $810 per beneficiary will potentially be paid for the set of MDPP services, equating to approximately $18 per session if all goals are achieved. MDPP payments will not be risk-adjusted for social risk factors or geography 19 HCPCS codes have been established to submit claims for payment If a beneficiary changes MDPP supplier mid-MDPP services period, the new supplier must obtain and maintain the beneficiarys MDPP record from the previous supplier. A $25 b Continue reading >>

Enrollment Is Open For Medicare Diabetes Prevention Program Suppliers

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 >>

Welld Health | Medicare Diabetes Prevention Program Help

Welld Health | Medicare Diabetes Prevention Program Help

With Medicare now offering hundreds of dollars per participant in reimbursement for diabetes preventative services, many organizations are interested in becoming part of the solution to this national health crisis. We dont want to scare the Dickens out of you, but if youre considering offering the Medicare Diabetes Prevention Program (MDPP) at your facility, there are several steps youll need to take. Lets take a look at this innovative program to see whats required of your organization and team members. Well try to demystify the difference in rules for the two government agencies running the program, and well give you a quick list of the steps you need to take. Dealing with two government entities on a single program, each with their specific needs, can lead to countless hours pouring over rules and regulations that can be confusing at first. As you come to understand the reporting and performance requirements it may feel like they are convoluted, contradictory or just plain crazy. But, when you understand how these two groups are collaborating, its easier to understand the motives behind this amazing opportunity. Centers for Disease Control and Prevention (CDC) CDC oversees and assures the quality of the National DPP: Centers for Medicare and Medicaid Services (CMS) CMS is implementing and evaluating the MDPP expanded model: Defines the Medicare covered MDPP services. Supports supplier enrollment and submission of claims Processes enrollment applications for qualifying organizations Provides resources to verify certain elements of beneficiary eligibility for MDPP Processes claims submitted by MDPP suppliers for payment Monitors suppliers compliance with Medicare requirements and MDPP supplier standard Its important to understand - you can run CDCs DPP without running Continue reading >>

Expanded Medicare Diabetes Prevention Program Rolls Out

Expanded Medicare Diabetes Prevention Program Rolls Out

Expanded Medicare diabetes prevention program rolls out Expanded Medicare diabetes prevention program rolls out The Centers for Medicare & Medicaid Services is in the fourth day of an innovative new diabetes prevention program that aims to save lives and as much as $182 million over 10 years by linking with community partners. Healthcare settings, including skilled nursing facilities, can also offer the program, which accepts Medicare beneficiaries with high body-mass indexes or other risk factors for developing diabetes. Nutritionists and dietitians play an important role in the program, which can be offered in approved health care and community settings. Nutritionists expect the program will create a better continuum of care for diabetes and increase referrals for medical nutrition therapy. But CMS has also certified lifestyle coaches who work in non-clinical settings, many with little to no previous Medicare experience. Under a pay-for-performance model, all providers will be reimbursed based on patient attendance and weight loss benchmarks. The CDC created the National Diabetes Prevention Program based on the results of the Diabetes Prevention Program Randomized Control Trial. The Centers for Medicare and Medicaid Innovation conducted a DPP model test that demonstrated cost effective risk reduction when lay health workers delivered the CDC-approved curriculum in YMCAs. In a 15-month period, the pilot saved about $2,650 per person enrolled. CMS ultimately decided not to offer an online version of the program, which started Sunday. This has left some concerned about access. America's Health Insurance Plans called on CMS to expand it so that beneficiaries can participate in virtual settings. The American Diabetes Association says more than 50% of people on Medicare ha Continue reading >>

Medicare Diabetes Prevention Program Offers Model For Chronic Care

Medicare Diabetes Prevention Program Offers Model For Chronic Care

Medicare Diabetes Prevention Program Offers Model for Chronic Care The Medicare Diabetes Prevention Program is expanding, offering private payers a model for chronic disease prevention and management. -CMSs Medicare Diabetes Prevention Program (MDPP) aims to address diabetes prevalence within the Medicare program, and may help other payers develop a model for chronic care, based on the MDPPs promising initial results. Diabetes is a pressing concern for CMS because of rising diabetes care costs within Medicare. In 2016, CMS estimated that Medicare spent $45 billion more on caring for members with diabetes than on costs for members without the disease. Nationally, rates of diabetes and prediabetes are high. The CDCs 2017 National Diabetes Statistics Report found that 20.8 percent of the nations 65 and older population has been diagnosed with diabetes and 4.2 percent have undiagnosed diabetes. The report also found that prediabetes affects nearly 23.1 million elderly adults. CMS leaders have high hopes that the early success of the MDPP can be scaled to improve Medicare outcomes and reduce costs, which may guide preventive care efforts in the commercial payer sector. The model first began as a prevention program supported by local and community organizations. CMS piloted the diabetes prevention program (DPP) from 2013 to 2015 through the agencys Health Care Innovation Awards program. The initial program was organized through a partnership between CMS, the YMCA, and other public and private partners. Piloting organizations hired and trained educators to teach classes focused on wellness behaviors such as healthy eating, exercise, and proper medication use. Educators taught a maximum of 24 classes each that reached 7000 Medicare beneficiaries. As a result of the program, 45 Continue reading >>

Cms Final Rule Extends Federal Diabetes Prevention Program To Medicare Beneficiaries

Cms Final Rule Extends Federal Diabetes Prevention Program To Medicare Beneficiaries

CMS Final Rule Extends Federal Diabetes Prevention Program To Medicare Beneficiaries The federal government is hoping to build upon the successes of their pilot diabetes prevention program, as they are moving forward with their plan to expand the prevention program model to all Medicare beneficiaries. The Department of Health and Human Services recently revealed that they are planning to expand the program, as it made impressive results in Affordable Care Act funded demonstration that involved YMCA. Counselors helped coach individuals who were at high risk for developing type-2 diabetes to eat healthy and improve their physical activity. The data shows that the efforts of the counselors have helped to make a five percent reduction in weight among the people who participated and saved an estimated 2,650 dollars per person for Medicare. Centers for Medicare & Medicaid Services officials noted in a blog post that the money is more than enough to cover the cost of the program. Evaluating the results of the model, a newly released final rule from CMS will expand the Medicare Diabetes Prevention Program model to all the Medicare beneficiaries starting from 2018. We know that fewer people with diabetes saves patients and Medicare money because they use fewer expensive prescription drugs and have fewer hospital visits, the post from CMS said. CMS also said that preventing diabetes would prevent the patients from the need to deal with a debilitating disease. The final rule from CMS follows a pilot model with YMCA USA using 11.8 million dollars as funding under the Affordable Care Act. Eligible Medicare beneficiaries who are enrolled in YMCA and are at high risk for diabetes can take part in the lifestyle-coaching program that is focused on improving the diet and physical activi Continue reading >>

Final Medicare Dpp Rule Adjusts Maintenance Period, Excludes Digital Providers

Final Medicare Dpp Rule Adjusts Maintenance Period, Excludes Digital Providers

Newsroom Published on: November 03, 2017 Final Medicare DPP Rule Adjusts Maintenance Period, Excludes Digital Providers CMS officials addressed a key concern that groups offering the Diabetes Prevention Program would bear too much financial risk, but they were unmoved on requests to let beneficiaries try the program more than once in a lifetime. CMS has agreed to limit the maintenance period of the Medicare Diabetes Prevention Program (DPP) to reduce burdens and financial risk on providers, but regulators did not budge on other key concerns when they finalized the program rule late Thursday. Medicare DPP will launch April 1, 2018, more than 2 years after former HHS Secretary Sylvia Mathews Burwell announced that a pilot by the Center for Medicare and Medicaid Innovation (CMMI) had shown the DPP would save $2650 per beneficiary over 15 months. An estimated 84 million Americans have prediabetes, including 22 million age 65 years and older. "Yesterday CMS released the Medicare Diabetes Prevention Program final rule which will guide the implementation of the Medicare DPP services next year. It is clear that CMS has closely listened to stakeholder feedback in several areas, including alignment and greater clarity for Medicare Advantage, which is now confirmed to start on April 1, 2018," said Brenda Schmidt, CEO of Solera Health. The DPP is a yearlong, evidence-based lifestyle change program with a CDC-approved curriculum. The original program featured 16 weekly core sessions followed by 7 monthly sessions. Evidence shows the program stops prediabetes from progressing as participants make modest changes and lose 5% to 7% of body weight. In a landmark study by the National Institutes of Health, the program showed a 58% reduction in participants progressing to diabetes. But as 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 >>

Webinar: Medicare Diabetes Prevention Program Expanded Model Expansion

Webinar: Medicare Diabetes Prevention Program Expanded Model Expansion

Webinar: Medicare Diabetes Prevention Program Expanded Model Expansion By the Centers for Medicare & Medicaid Services On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) 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 MDPP expanded model will allow Medicare beneficiaries to access evidence-based diabetes prevention services, with the goal of a lower rate of progression to type 2 diabetes, improved health and reduced costs. The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of prediabetes. The clinical intervention consists of a minimum of 16 intensive core sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum furnished over six months 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 completing the core sessions, less intensive follow-up meetings furnished monthly will help ensure that the participants maintain healthy behaviors. The primary goal of the expanded model is at least 5 percent weight loss by participants. The Calendar Year 2017 Medicare Physician Fee Schedule (CY 2017 PFS) final rule, published in November 2016, established the expansion and aspects of the expanded model policy framework. The CY 2018 PFS finalizes additional policies necessary for suppliers to begin providing MDPP services nationally in 2018, including the MDPP payment structure, as well as additional supplier enrollment requiremen Continue reading >>

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