Proposed Policies for the Medicare Diabetes Prevention Program (MDPP) Expanded Model for the Calendar Year 2022 Medicare Physician Fee Schedule
On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2022 Physician Fee Schedule (PFS) proposed rule, which proposes changes to the Medicare Diabetes Prevention Program (MDPP) expanded model intended to boost supplier enrollment, with a 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 proposed changes would make it easier for local suppliers to participate and reach their communities, and may allow CMS to perform a more robust evaluation of the expanded model.
Provider Enrollment Medicare Application Fee Waiver for MDPP Suppliers
We are proposing to utilize 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. During the COVID-19 Public Health Emergency (PHE), CMS waived the Medicare enrollment fee for new MDPP suppliers and observed an increase in supplier enrollment. The proposed changes would waive the Medicare enrollment fee for MDPP suppliers beyond the end of the PHE.
We believe that granting a waiver of the fee for MDPP suppliers to extend beyond the COVID-19 Emergency Declaration Blanket Waiver may 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 is proposing 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 proposal would make the MDPP services timeframe consistent with the Centers for Disease Control and Prevention (CDC) National DPP. We also anticipate this proposal would relieve additional burden and cost to the MDPP supplier.
If finalized, we expect more eligible organizations will enroll as MDPP suppliers, which would increase the number of locations beneficiaries may access the MDPP set of services. If finalized, this change would apply 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% weight loss and attendance requirements.
In conjunction with the proposed change to remove the Ongoing Maintenance sessions phase from the MDPP services period, we are proposing to redistribute a portion of the Ongoing Maintenance sessions phase performance payments to certain Core and Core Maintenance Session performance payments. We propose to increase performance payments for MDPP beneficiary achievement of the 5% weight loss goal, as well as continued attendance during each core maintenance interval.
Increasing the first year payment amounts to suppliers and waiving the Medicare enrollment fee should increase access to MDPP, resulting in more utilization of the MDPP set of services.