Medicare Compliance & Reimbursement

Plus: See the latest fee schedule proposals on the MDPP.

With a third of Medicare beneficiaries diagnosed with diabetes, it shouldn’t surprise anyone that the feds continue to double down on prevention and management policymaking.

Here’s a look at four critical items to know.

1. CDC Offers Providers Extra Help Via the National DPP

No matter your specialty, scope, or practice size, you probably see patients with diabetes — and the Centers for Disease Control and Prevention (CDC) wants to help. The CDC started the National Diabetes Prevention Program (DPP) in 2010, addressing the “increasing burden” of diabetes in the United States. Under the helm of the program, the CDC has a plethora of healthcare provider tools and tips, infographics, patient resources, staff training, and more. Check out the latest DPP news and guidance at www.cdc.gov/diabetes/ prevention/index.html.

2. CMS Hopes to Extend COVID Flexibilities for MDPP Providers

The Centers for Medicare & Medicaid Services wants to extend the Medicare Diabetes Prevention Program (MDPP) Expanded Model’s Public Health Emergency (PHE) flexibilities for another four years. As it currently stands, the expansion is set to expire on Dec. 31, 2023. But CMS recently outlined extending through Dec. 30, 2027 in the calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) proposed rule — as long as providers and suppliers who offer MDPP services utilize a CDC organization code.

“The proposed flexibilities include the virtual delivery of MDPP services through distance learning. CMS also proposes simplifying MDPP’s current performance-based payment structure by allowing fee-for-service payments for attendance by people with Medicare,” the agency notes in a fact sheet on the proposals.

3. MPFS Proposals Aim to Clarify Previous DSMT Provisions

Adjacent to the MDPP expansion, CMS proposes amending a Diabetes Self-Management Training (DSMT) policy that originated in the CY 2022 rulemaking cycle, and that concerns how registered dieticians (RDs) and nutrition professionals provide medical nutrition therapy (MNT). Stakeholders note that the current wording of the provision is confusing, according to the CY 2024 MPFS proposed rule. CMS “propose[s] to clarify that a RD or nutrition professional may bill for, or on behalf of, the entire DSMT entity as the DSMT certified provider regardless of which professional furnishes the actual education services,” the rule says.

“We propose to clarify § 410.72(d) to provide that, except for DSMT services furnished as, or on behalf of, an accredited DSMT entity, registered dietitians and nutrition professionals can be paid for their professional MNT services only when the services have been directly performed by them,” CMS explains.

The CY 2024 MPFS proposed rule was published in the Federal Register on Aug. 7. The final rule is expected in late fall, but you can review the proposals at www.govinfo.gov/content/pkg/ FR-2023-08-07/pdf/2023-14624.pdf.

4. CMS-OMH Breaks Down Diabetes in New Infographic

The CMS Office of Minority Health (CMS-OMH) publishes the Health Equity Quarterly, which offers updates and insight on the agency’s equity-focused initiatives, coverage, and healthcare. In the summer 2023 edition, CMS-OMH looks at the diabetes numbers across Medicare and various demographics. “The infographic highlights diabetes prevalence among Medicare beneficiaries in the community,” CMS says. “While 3.7 million people in the U.S. reported being diagnosed with diabetes, this infographic shows how these disparities are visible among Medicare enrollees.”

Understanding how to both prevent and manage diabetes for Medicare beneficiaries while addressing health equity and disparity is essential, maintains the CMS-OMH. Peruse the statistics in the infographic at www.cms.gov/files/document/ cms-diabetes-infographic-6-2023.pdf.