CDC’s Diabetes Prevention Program Questions and Answers

Do you have questions regarding the National Diabetes Prevention Program?  Over the next few weeks we will feature posts that address questions about the program.

First let’s begin by defining the terms.

Diabetes Prevention Program (DPP) was the research trial led by the National Institutes of Health with financial and scientific expertise from Centers for Disease Control and Prevention (CDC), and others.

National Diabetes Prevention Program (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 Medicare Diabetes Prevention Program (MDPP) refers to the new Medicare Part B benefit for the National DPP lifestyle change intervention for eligible Medicare beneficiaries.

Q. What is the difference between the National Diabetes Prevention Program and the Medicare Diabetes Prevention Program?

A. The National Diabetes Prevention Program (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 Medicare Diabetes Prevention Program (MDPP) refers to the new Medicare Part B benefit offering coverage for the National DPP lifestyle change intervention for eligible Medicare beneficiaries.  Programs must have recognition by the Center for Disease Control and Prevention (CDC) to deliver the MDPP benefit.

Q. Is it mandatory for lifestyle groups to be certified for program accreditation and Medicare reimbursement?

A. Medicare will require NDPP programs to have full CDC recognition (administered by the CDC Diabetes Prevention Recognition Program, part of the National DPP) to be eligible to enroll in Medicare as Medicare Suppliers.  CMS may consider another category of recognition that would be addressed in future rulemaking.

Q. Can an RDN apply for a National Provider Identifier (NPI) number even if not planning to use it quite yet?  Does
it require renewal?

A. A registered dietitian nutritionist (RDN) can apply for an NPI at any point in time, whether for current or future use.  The Academy recommends that every RDN have an NPI regardless of employment status or place of work, or whether the NPI is being used by the RDN or an organization for billing purposes.  NPIs are one way to demonstrate RDN workforce availability to payers including Medicare, private payers, and state Medicaid agencies.  An NPI does not require renewal and it never expires.  Nutrition and dietetics technicians, registered (NDTRs) and other nutrition and dietetics practitioners can also obtain NPIs at any time.  There is a specific NPI taxonomy category for “dietetic technician, registered.”  Nutrition and dietetics practitioners who are not RDNs or NDTRs can select “Health Educator” for the taxonomy.

For more information on how to obtain an NPI, visit http://www.eatrightpro.org/resource/practice/getting-paid/getting-started-with-payment/national-provider-identifier-faqs

Q. I’m unclear as to whether each health coach needs an individual NPI or if the program can use the hospital NPI?

A. Each Lifestyle coach who delivers the NDPP to Medicare beneficiaries under the new Medicare benefit (MDPP) will need an individual NPI.  Programs that apply to enroll as Medicare Suppliers of the MDPP are required to submit and maintain a coach roster with NPI numbers for all coaches.  Individual coach NPIs will not be used forbilling purposes in the MDPP.  The Medicare Supplier (must be a program) will use the program NPI to submit claims to CMS.

Q. When do you apply for the MDPP NPI number?

A. Organizations who want to deliver the MDPP benefit will need to provide a list of coaches and their NPIs when they apply to enroll as a Medicare Supplier. Organizations can apply for Medicare Supplier enrollment if the NDPP program has already obtained full CDC Recognition.  https://nccd.cdc.gov/ddt_dprp/registry.aspx.

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.