Medicare Diabetes Prevention Program – Physician Fee Schedule

In our final post related to the Physician Fee Schedule (PFS) final rule (read more HERE), we explore the Medicare Diabetes Prevention Program (MDPP), a new Medicare benefit anticipated to be effective beginning January 1, 2018.

As a new program, the Centers for Medicare & Medicaid Services (CMS) will engage in at least one additional round of rulemaking, but offered some early policies and details on the benefit. Specifically, CMS finalized the scope of the benefit, defined eligibility for beneficiaries, and began outlining policies related to suppliers.

The program will be open to Medicare beneficiaries that exceed certain body mass index (BMI) levels and have clinical indicators of pre-diabetes. The benefit itself will consist of a twelve-month program with weekly session in the first six months, followed by monthly sessions for the second six months. Beneficiaries that achieve minimum weight loss will be eligible to continue in the program with ongoing maintenance sessions.

CMS deferred several significant decisions related to MDPP suppliers, but did note in the final rule at suppliers would need to separately apply as an MDPP supplier, even if already enrolled as a Medicare supplier. The agency will review MDPP suppliers under their highest screening level, which requires fingerprinting and background checks for all individuals with a 5 percent or greater direct or indirect ownership interest. Organizations that wish to offer MDPP services will also need to receive recognition from the Centers for Disease Control (CDC) Diabetes Prevention Recognition Program (DPRP), a process CMS encouraged interested parties to begin seeking now.

In future rulemaking, expect CMS to offer more details on supplier enrollment, virtual services, and payment. More information on the MDPP is contained in our issue brief HERE.

2016-12-02T22:57:13+00:00 November 30th, 2016|CMS, Legislation & Policy|