Medicare Compliance & Reimbursement

Voice your opinions on 9 key issues for DPP expansion.

Background: The DPP is a structured lifestyle intervention for pre-diabetic individuals. The clinical intervention includes 16 intensive “core” sessions in a group-based setting that provides dietary coaching, lifestyle intervention, and moderate physical activity, all with the goal of preventing diabetes. After the 16 core sessions, participants attend less-intensive monthly follow-up meetings.

The DPP took up a major chunk of the recently proposed rule that also makes significant changes to the calendar year 2017 Physician Fee Schedule (PFS).

Potential changes: Beginning on Jan. 1, 2018, CMS would expand the DPP into Medicare, allowing DPP suppliers recognized by the U.S. Centers for Disease Control and Prevention (CDC) to submit claims to Medicare for providing diabetes prevention services. In the rule, CMS proposes a process for suppliers to enroll in the DPP so they can furnish services and bill Medicare immediately after the program becomes effective.

“Through expansion of the Diabetes Prevention Program, beneficiaries across the nation will be able to access a community-based intervention that prevents diabetes and keeps people healthy,” said CMS Acting Principal Deputy Administrator and Chief Medical Officer Patrick Conway, MD, MSc. in a July 7 statement. “This is part of our efforts for better care, smarter spending, and healthier people.”

To fulfill the expansion requirement for a program model, the CMS OACT needs to certify the model as a cost savings program that reduces net Medicare spending and the HHS Secretary must determine that the program demonstrates the ability to improve the quality of patient care without limiting coverage or benefits. The DPP met all these requirements.

In the proposed rule, CMS has laid out the following specific issues for which it is soliciting public comments:

• Medicare DPP supplier enrollment;
• DPP payment structure;
• IT considerations and capabilities;
• Characteristics of eligible beneficiaries;
• Program integrity initiatives;
• Site of service requirements;
• Learning and technical assistance requirements;
• Quality measurement and reporting; and
• Expansion timeframe.

You can submit your comments on the proposed rule until Sept. 6. To learn more about the DPP, visit www.cdc.gov/diabetes/prevention/lifestyle-program/index.html and www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-07.html.