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November | December 2017
 Plugged into Prevention

Revisions to CMS Physician Fee Schedule Final Rule

By: Natalie Blum, MPH, AADE Manager of Prevention

Earlier this year, AADE submitted a letter to the Centers for Medicare and Medicaid Services (CMS) commenting on the Medicare Physician Fee Schedule proposed rule, which suggested changes and highlighted areas of agreement. Our comments covered issues such as diabetes treatment expansion, distribution of payment, and consideration of telehealth.

CMS took AADE’s comments and many other organizations’ comments into consideration and made some major changes to policies in its Medicare Physician Fee Schedule Final Rule. The most notable revisions include changes to the length of Medicare Diabetes Prevention Program (MDPP) services, the performance-based payment structure, and the Healthcare Common Procedure Coding System’s (HCPCS) G-codes.

Like the Diabetes Prevention Program (DPP), the MDPP focuses on preventing progression of type 2 diabetes in individuals with an indication of prediabetes. A key goal of MDPP is for beneficiaries to reduce their weight by at least five percent from baseline by the end of the first year. If reached, they will be eligible for ongoing maintenance sessions in the second year. The 2018 proposed rule proposed MDPP services for up to three years, including two years of ongoing maintenance; however, the final rule settled on a total of two years of MDPP services. Persons seeking to prevent or delay type 2 diabetes are also only eligible for MDPP once in their lifetime. CMS believes that the one-time benefit will be more likely to motivate people than allowing them to re-enroll at any time. Suppliers will also be able to provide in-kind incentives to beneficiaries to increase patient engagement in healthy behavior change.

The final rule appeared in the November 2, 2017 Federal Register. For more information on AADE’s Prevention Network and services, please visit preventionsimplified.org.

 

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