CDC’s Diabetes Prevention Program – Questions and Answers #2

Q. Is it possible for someone in private practice to offer the MDPP as a solo practitioner?

A. Solo practitioners would need to start a National DPP and obtain full CDC Recognition to apply to enroll as a Medicare Supplier for the MDPP.  Individuals in private practice can also partner with existing or new programs to provide the lifestyle coaching or serve as a program coordinator as independent contractors.  The program would need to obtain the solo practitioner’s NPI for the coach roster.  Medicare pays the recognized Medicare Supplier, and the program would pay the practitioner providing services for lifestyle coaching.

Q. If someone is <65 and has prediabetes but is not overweight, is he/she eligible for the program (i.e., the MDPP benefit)?

A. No. Medicare beneficiaries with a body mass index (BMI) of < 25 are not eligible to participate in the Medicare DPP benefit.  The Medicare criteria for the Part B benefit is a BMI of ≥ 25 and abnormal blood glucose results.  The Medicare DPP is an important new benefit to help Medicare beneficiaries prevent and/or delay diagnoses of diabetes, yet it does not meet the needs of all populations with prediabetes.

A note about individuals with Medicare Advantage plans or other individuals < 65 with private insurance: It is possible that individuals with private insurance, including Medicare Advantage plans, who have prediabetes and BMI < 25, have a benefit for MNT that may cover a diagnosis of prediabetes. Individual plan benefits and coverage policies determine what services are covered benefits and terms/conditions for coverage. We encourage RDNs and organizations to confirm benefits for MNT in persons with prediabetes.

Q. How do you become a Master Trainer?

A. As of the date of the webinar, there are three organizations (Diabetes Training and Technical Assistance Center at Emory University, American Association of Diabetes Educators, and the Diabetes Prevention Support Center of the University of Pittsburgh) that currently provide Master Training.  The minimum required qualifications for application to a Master Trainer Program are:

  • Previous completion of Lifestyle Coach Training from a CDC-recognized national provider
  • Affiliation with an organization that has pending or full CDC recognition
  • Successful delivery and experience with the National Diabetes Prevention Program

Some of the organizations also require the applicant to be a health care professional with a minimum of a bachelor’s degree in a health-related field or if not, substantive experience.  There is an application form to be completed, letters of recommendation from a supervisor or a professional who can provide information about your experience and performance in delivery of a lifestyle change program, and often a phone interview.  Successful applicants attend a 2-day training, similar to the Lifestyle Coach Training Program, to become qualified to become a Master Trainer.  The fees range from $1500-$1650 which includes the training and the membership/agreement fee for post-training technical assistance and licensing of the training materials.  Master Trainers can train lifestyle coaches in their own and partner organizations.

Q. Can RDNs in private practice order blood tests for diabetes screening?

A. The Academy recommends that RDNs refer to the Comprehensive Scope of Practice Resource for the RDN which can guide the RDN to the resources and options that can be used to evaluate whether the RDN can safely and effectively provide an expanded practice skill and advance individual practice.  Case Study: Initiating Orders for Nutrition-Related Laboratory Tests for RDNs Practicing in Hospital, Ambulatory and Private Practice Settings Academy Store: http://www.eatrightstore.org/product/AE37FD36-0C17-422C-91F6-E3C9DC845986

Quality Management Webpage: http://www.eatrightpro.org/resource/practice/quality-management/scope-of-practice/scope-of-practice-terms-studies-and-tips

Quality Management Short Link: http://www.eatrightpro.org/scope.  Scroll down to Case Studies on the Scope Webpage.

Q. How long will Medicare pay for maintenance sessions?

A. Beneficiaries will have access to ongoing maintenance sessions after the MDPP core benefit (1st 12 months of the program).  At the time of the webinar CMS had not placed any limits on how long CMS will pay for ongoing maintenance sessions.  Eligible beneficiaries will have access to ongoing maintenance sessions after the MDPP core benefit if they achieve and maintain the required minimum weight loss of 5%.  CMS is defining maintenance of weight loss, which allows a beneficiary to access ongoing maintenance sessions, as achieving the required minimum weight loss from baseline weight at any point during the previous 3 months of the core maintenance or the ongoing maintenance sessions.  CMS will propose a limit on the duration of CMS payments for ongoing maintenance sessions in future rulemaking.  As a reminder, there are six monthly core maintenance sessions in months 6 through 12 of the year-long program in which beneficiaries are eligible to participate, regardless of weight loss, but CMS has not issued final rules about payment for the core maintenance component or any component of the MDPP benefit.

 

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.

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.