CDC’s Diabetes Prevention Program – Questions and Answers #4

Q. There’s a lot of talk about obesity and Type 2 diabetes and it seems a lot of the program is about managing weight.  What does the program have available (lifestyle-wise) for those T2D patients who have lost weight since diagnosis and/or who are not overweight?

A. The National DPP and the MDPP benefit are for individuals with prediabetes/high risk for type 2 diabetes and are overweight.  It is not for people who already have diabetes.  Medicare Part B beneficiaries with diabetes have access to the following nutrition benefits:

  • Medical Nutrition Therapy (MNT): Medicare Part B beneficiaries have a benefit for 3 hours of MNT during the first 12 months of diagnosis and 2 hours of MNT in each year following the diagnosis of diabetes, chronic kidney disease, or post kidney transplant.  Beneficiaries can have additional hours of MNT as long as the RDN obtains a new referral during each year of treatment.  For more information visit http://www.eatrightpro.org/resource/practice/getting-paid/nuts-and-bolts-of-getting-paid/diabetes-and-renal-disease-resources.
  • Diabetes Self-Management Training (DSMT): DSMT includes education for eating healthy, being active, monitoring blood sugar, taking drugs, and reducing risks.  Medicare may cover up to 10 hours of initial DSMT.  This training may include 1 hour of individual training and 9 hours of group training in the first year, and 2 hours of follow-up training in subsequent years.

Q. This program – short of the curriculum – seems similar to an IBT for Obesity program.  Any idea whether there might be an overlap in terms of payers and which program might be more profitable for the health care provider or RDN?

A. Medicare’s Intensive Behavioral Therapy (IBT) for Obesity benefit and the Medicare Diabetes Prevention Program benefit are considered distinct benefits.  They each have different eligibility criteria and coverage parameters, and requirements for CMS payment.  IBT for Obesity refers to a specific Medicare Part B benefit for beneficiaries with a BMI ≥ 30 that can be delivered in primary care settings.  Other payers (non-Medicare) may cover diabetes prevention programs as well as also offer benefits related to obesity treatment (e.g., MNT or programs).  Each payer sets its own eligibility requirements and payment policies.  RDNs and other health care providers need to evaluate the costs and benefits of providing services based on their organization/practice’s mission, business model, costs, amount of reimbursement, other sources of revenue, and target market, etc.

To learn more about the Medicare IBT benefit and providing obesity services to other populations, check out the Academy’s toolkit, Intensive Behavioral Therapy for Obesity: Putting it into Practice that is free for members: http://www.eatrightstore.org/product/D8F05FA8-6103-4804-BB58-F2BDF83F9138.

Q. In order to be a Medicare recognized program would the initial 16 sessions in the first 6 months need to be carried out consecutively?  I currently run our DPP in my workplace. However, participants have slowly trickled in and are not all attending the same sessions, and we have conducted 16 individual sessions; would this
count?

A. In order to become a Medicare recognized program, the program must achieve full CDC recognition and enroll as a Medicare Supplier.  The core MDPP benefit is for 12 consecutive months and must consist of at least 16 weekly core sessions over months 1-6, and at least 6 monthly core maintenance sessions over months 6-12.  CMS will address payment for MDPP services in future rule-making.

Q. Can the program be reimbursed at a hospital outpatient office or does it require reimbursement at a doctor’s office outpatient?

A. Yes.  The hospital based program would need to enroll as a Medicare Supplier of the NDPP.

Q. I was trained as a life coach for the original CDC DPP in 2013.  I have since left the job.  Do I need to get new certification for the program or will the original 2 day training be transferable?

A. Certification as a lifestyle coach does not expire, however, organizations that are providers of NDPPs may set policies and/or requirements regarding current training.

Q. Is the EPIC EHR flow sheet shown in the presentation available to all EPIC users or does the flow sheet need to be purchased separately?

A. The flowsheets are a custom build and are not an EPIC product.

Q. To run an effective NDPP, can you elaborate more clearly on the mandatory resources to run a CDC-recognized program?

A. The mandatory resources needed to run an NDPP CDC recognized program are an approved CDC curriculum, trained lifestyle coaches, and eligible participants to form a group-based program.

 

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.