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
  • 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:

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

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.

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.

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:

Quality Management Webpage:

Quality Management Short Link:  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.

Eat to Boost Immunity: Tip # 4


Here is the fourth nutritional strategy that you can share with clients to help ensure optimal immune health during these cold winter months.

Consume foods with naturally occurring probiotics to improve gut health

New and emerging research regarding gut bacteria shows that our gut microbiome has a direct impact on brain and immune health.

While a probiotic supplement is one way to build up healthy bacteria within the gut, first start by incorporating foods with natural probiotics into your daily regime.

These include: yogurts and aged cheeses, kefir, sauerkraut, miso, tempeh, kimchi, sour pickles and kombucha.

By consuming 2-3 probiotic-rich foods daily, you are feeding the healthy bacteria in your gut that in turn can lend to a stronger immune system.

Kristen Chang
Kristen Chang

Kristen Chang is a Certified Specialist in Sports Dietetics and triathlete, currently serving as the President of the Southwest Virginia Academy of Nutrition & Dietetics. She works as the owner of the nutrition private practice Real Food For Fuel, LLC and adjunct instructor for Virginia Tech and Radford University. Kristen lives in Blacksburg, VA with her husband, Jordan, and dogs Kenya and Sunny.

Combining Services to Increase Access to Local Produce

Summer Vegetation for Everyone

Summer is a wonderful time to buy fresh produce- everything seems to be in abundance! The juicy tomatoes are making their mark on every sandwich and salad, the summer squash add their bright color and flavor to any dinner dish, and the bountiful fresh herbs can be thrown into every single meal to add a flavor profile that is complex in taste but easy in practice. What an opportune time to fill up on the local Virginia produce!

But, what about those that cannot always afford to purchase fresh produce or shop at local farmer’s markets?

The Farmers Market Nutrition Program

The Farmers Market Nutrition Program (FMNP) is supported by the VA Department for Aging and Rehabilitation Services-Division of Aging, the VA Department of Agriculture and Consumer Services, and the USDA. The FMNP provides checks to Seniors and WIC families for the purchase of local produce at Farmers Markets. The Augusta-Staunton Health Department, one of seven serving the Central Shenandoah Health District, began issuing Farmer’s Market checks 2 years ago to their WIC participants hoping to enable them to obtain fresh fruit and vegetables. This Health District is in fact the largest in Virginia, in terms of square mileage, and is filled with rural areas.

Another Challenge – Access

For some living in rural areas, access to food assistance programs is a major challenge. Through a survey the Augusta-Staunton Health Department conducted with their WIC clients, they came to understand that while their clients were enthusiastic about the possibility of receiving local produce, many did not have the time nor means of transportation to travel to their nearest Farmers Markets during their operational days.

Increasing Access – The Farmer’s Market Initiative

To address this issue and increase access to produce, the Augusta-Staunton Health Department WIC Program decided to bring the farmers market directly to the WIC location. The goal is to bring the local farmers to the Health Department on a day when WIC clients will already be coming to the Health Department for other WIC services, thereby reducing the difficulty of transportation issues.

Along with several partners:

  • Project GROWS, a non-profit farm located in Verona
  • Troyer’s Produce located in Waynesboro
  • JMD Farms located in Staunton

Project GROWS, who acts as the Fiscal Manager, was chosen for this joint venture

  • both Project GROWS and the WIC Program have common goals of improving the health of young children through access to nutritious foods
  • because of their experience is successfully running two other Farmers Markets in Augusta County.


The WIC participants are able to come in for their appointments, check-ups and nutrition education programs, receive their Farmers Market Vouchers, and then proceed to spend their Farmers Market checks to purchase fresh produce from the farmers right there on the Health Department property!

Since the start of the Health Department Farmers Market Initiative on July 8th, the return rate of the Farmers Market checks has increased dramatically. This successful initiative means that

  • WIC participants are able to have easier access to fresh produce that promote their good health
  • local farmers are finding a new way to increase their selling capacity, which ultimately enhances the local economy.

You can find pictures from their Farmer’s Market on Facebook at the Central Shenandoah Health District and you can contact the Staunton Health Department at (540) 332-7830 to find out more information on who is able to receive these Farmers Market checks as well as ways you can help enhance their initiative.

You can also contact Project GROWS at if you are looking to volunteer your time on the farm harvesting and tending to their beds!

It always feels good doing something to help out your community and volunteering with a local farm can provide a whole new appreciation for the fresh local food we are able to enjoy here in Virginia!

Jenna Clark from Project GROWS

Photo 1: Jenna Clark, from Project GROWS, sets up for the first Health Department Farmers Market. Credit to the Facebook page of Central Shenandoah Health District.


Trayers Produce and Project GROWS

Photo 2: Troyer’s Produce and Project GROWS attract some happy clients during the Farmers Market. Credit to the Facebook page of Central Shenandoah Health District.



Kat Huntley

Kat Huntley is a senior at James Madison University, where she majors in Dietetics and serves as the Vice President of the Dietetics Association. She enjoys being an engaged community member and looks to stay active in her volunteer work geared towards improving the equity of healthy food access. She has a passion for advocating for the health of the vulnerable and believes that food is a fundamental part of life that has the power to bring people together! Contact: