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2018 Physician Fee Schedule Further Defines New Medicare Diabetes Prevention Program

Oct 06, 2017

The CDC estimates that the number of individuals with diabetes will double by 2050, affecting one in three adults. One answer to this growing problem is the CDC’s evidence-based National Diabetes Prevention Program (National DPP), which helps individuals at high risk prevent or delay on the onset of type 2 diabetes. 

A little history

Diabetes is a costly disease, and Medicare spends one out of every three dollars on diabetes. In 2016, the Medicare Diabetes Prevention Program (MDPP) expanded model was established when it was determined that the National DPP clinical trial, conducted by the YMCA, showed that Medicare saved $2,650 over 15 months for every Medicare beneficiary enrolled in the program. With the positive outcomes from the clinical trial, CMS proposed to expand the National DPP to Medicare beneficiaries. 

Moving forward

The recently released 2018 Physician Fee Schedule (PFS) Proposed Rule included details on how to implement and obtain coverage for MDPP services starting in 2018. The ruling also included details on the proposed MDPP payment structure, supplier enrollment requirements and compliance standards. AADE’s view is that this proposal opens up major opportunities for diabetes educators and the services they can offer.

The MDPP expanded model is a structured intervention that includes a minimum of 16 core sessions over a six-month period. Following the core sessions are maintenance sessions to continue to reinforce learnings on healthy behaviors. The program is typically delivered in a group-based setting that provides education and training on nutrition, increased physical activity, and behavior change with the goal of having program participants obtain at least a 5 percent weight loss. 

AADE reviewed and provided comments that were designed to best represent DSMES programs, diabetes educators and our vast membership.

AADE commends CMS for moving forward with MDPP implementation in a timely fashion and is pleased that CMS and CDC’s Diabetes Prevention Recognition Program (DPRP) are working to cohesively align. We now know that supplier enrollment to become a MDPP supplier will be effective on January 1, 2018 and the furnishing of MDPP services within the expanded model will begin April 1, 2018.

AADE already offers services to assist programs through the process of CDC Recognition and National DPP implementation, as well as completing the CMS application to become an MDPP Supplier. Learn more about the AADE Prevention Network.

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