Final Policies for the Medicare Diabetes Prevention Program (MDPP) Expanded Model for the Calendar Year 2022 Medicare Physician Fee Schedule
On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2022 Physician Fee Schedule (PFS) final rule, which finalizes changes to the Medicare Diabetes Prevention Program (MDPP) expanded model. These policies are intended to boost supplier enrollment, with the goal of increasing beneficiary participation and access to services that can help them develop and maintain healthy behaviors to prevent onset of type 2 diabetes. We anticipate that these final changes will make it easier for local suppliers to participate and reach their communities. If the anticipated increased participation occurs, this will allow CMS to perform a more robust evaluation of the expanded model.
Provider Enrollment Medicare Application Fee Waiver for MDPP Suppliers
We are finalizing our proposal to use the CMS Innovation Center’s waiver authority to waive the provider enrollment Medicare application fee for all organizations that submit an application to enroll in Medicare as an MDPP supplier on or after January 1, 2022. This change will waive the Medicare enrollment fee for MDPP suppliers beyond the end of the public health emergency (PHE). We believe that granting a waiver of the fee for MDPP suppliers to extend beyond the COVID-19 Emergency Declaration Blanket Waiver will increase MDPP supplier enrollment, which will ultimately improve beneficiary access to the expanded model and may lead to a more robust evaluation.
Shorten MDPP Services Period to One Year On a Prospective Basis
CMS has finalized the proposal to shorten the MDPP services period to one year by removing the Ongoing Maintenance sessions phase (months 13-24) of the MDPP set of services for beneficiaries starting MDPP on or after January 1, 2022. This final rule will make the MDPP services timeframe consistent with the Centers for Disease Control and Prevention (CDC) National DPP. Aligning with the CDC National DPP in this way ensures consistency for suppliers, which we believe will increase the number of suppliers providing more access for potential beneficiaries. We also anticipate this final policy will relieve additional burden and cost to MDPP suppliers.
We expect more eligible organizations will enroll as MDPP suppliers, which will increase the number of locations where beneficiaries may access the MDPP set of services. This change applies to all MDPP beneficiaries who start the MDPP set of services on or after January 1, 2022. MDPP beneficiaries who were participating in the MDPP set of services on or before December 31, 2021 may continue with the ongoing maintenance phase if they maintain 5 percent weight loss and attendance requirements.
In conjunction with the finalized change to remove the Ongoing Maintenance sessions phase from the MDPP services period on a prospective basis, we are finalizing a policy to redistribute all of the Ongoing Maintenance sessions phase performance payments to certain Core and Core Maintenance Session performance payments. We will maintain the current 2021 performance payment amount for achievement of the 5 percent weight-loss goal. However, we will increase the payment amounts for the attendance only achievement goals to incentivize attendance.
We believe that these final policies will reduce the administrative burden and costs associated with the ongoing maintenance sessions phase to MDPP suppliers. We also anticipate that these changes will increase supplier enrollment and beneficiary access to the expanded model, resulting in more utilization of the MDPP set of services.