CDC’s Diabetes Prevention Program – Questions and Answers #3

Q. Will Medicare pay for the program participants that are in the pending recognition status?

A. Pending recognition status is the initial application process for CDC diabetes prevention program recognition (DPRP) for the NDPP.  A program with pending recognition is not eligible for Medicare payments.  Medicare will be requiring organizations to have Full CDC Diabetes Prevention Program Recognition to enroll as Medicare Suppliers.  CMS is considering another category of recognition which would be addressed in future rule-making.

Q. It was mentioned that NDPP will only be reimbursed from Medicare for face-to-face groups initially.  Would a live, telephone group be considered face-to-face?

A. No, telephonic delivery is not considered face-to-face.  CMS will not pay for non-face-to-face delivery of the program in 2018.  Future rule-making will address virtual delivery and payment.

Q. How different is the CDC approved DPP from the American Diabetes Association’s Diabetes Self-Management and Education Program?

A. The National DPP and Diabetes Self-Management and Education (DSME) program are different programs altogether.  The National DPP is intended to prevent the onset of type 2 diabetes in populations with prediabetes.  DSME programs provide standardized education and training for populations already living with
diabetes.  DSME programs are recognized by the American Diabetes Association or accredited by the American Association of Diabetes Educators.  Programs that deliver the National DPP are recognized/accredited by the CDC.  DSME programs that also wish to deliver the National DPP must go through the process to become CDC-Recognized (full) and enroll as a Medicare Supplier to deliver the National DPP to Medicare beneficiaries with prediabetes.

Q. Does one need to be a certified diabetes educator (CDE) to be a DPP Lifestyle Coach?

A. One does not have to be a CDE, health care provider, or have certain credentials to become a DPP Lifestyle Coach.  Please see slide 26 for eligibility and skills.

Q. Is the NDPP/MDPP a voluntary program that RDNs engage in?  Is there a financial incentive, billing etc.?

A. The National DPP is the overarching program/framework for implementation of the lifestyle change intervention for those with prediabetes/high risk for type 2 diabetes.  The MDPP refers to the new Part B benefit for the National DPP lifestyle change intervention for Medicare beneficiaries.  The National DPP and MDPP are linked and are not really two separate programs.  Organizations must become part of the National DPP since they must attain full recognition by the CDC to deliver the MDPP benefit to enroll as a Medicare Supplier and be paid by Medicare.  CDC Recognition for DPP programs is voluntary, but is increasingly being used by payers as a requirement for
reimbursement/payment as it is with the MDPP benefit.

Programs with CDC recognition have the ability to offer the National DPP to consumers with private insurance who have benefits and coverage for diabetes prevention programs, and/or to provide the program for a fee in instances where consumers do not have an insurance benefit for diabetes prevention programs.  Not all payers require full recognition to begin offering the program.  Some payers may provide consumer coverage and pay for programs with pending status, but are likely to expect the program to achieve and maintain full recognition.  Depending on the setting, there can be numerous benefits from offering the National DPP, not to mention the benefits of providing a program demonstrated to prevent the onset of disease.  Benefits of offering the National DPP and of becoming a Medicare Supplier of the MDPP were highlighted in Marcy Kyle’s presentation of the webinar.  We recommend that you listen to the recorded webinar provided.

 

About the Author: Joyce Green Pastors, MS, RD, CDE, VAND Member and one of the Virginia Diabetes Council Board Members, participated in a webinar on May 24th, 2017 for the Academy of Nutrition and Dietetics about diabetes prevention.  We thank them for sharing information from this webinar with us.