The MDPP Expanded Model uses an evidence-based curriculum to engage and educate Medicare beneficiaries who are at risk for developing type 2 diabetes. More than a quarter of people over age 65 have diabetes, and diabetes is the most expensive chronic disease in the United States. Eligible beneficiaries can enroll in the program through a vast array of providers (MDPP Suppliers) in multiple in-person or online formats. Beneficiaries participating in the program commit to attending 16 weekly sessions, followed by 6 monthly maintenance sessions. Over the course of the program, beneficiaries learn ways to adopt healthy, lasting lifestyle changes.
Background
The MDPP Expanded Model is an extension of the Diabetes Prevention Program (DPP) tested in Round One of the CMS Innovation Center’s Health Care Innovation Awards. The final rule establishing the expansion was finalized in 2016. A subsequent rule established policies related to the set of MDPP services, including beneficiary eligibility criteria, the MDPP payment structure, and supplier enrollment requirements and compliance standards aimed to enhance program integrity.
In 2023, CMS extended the rule allowing MDPP suppliers to use specific MDPP COVID-19 Public Health Emergency (PHE) flexibilities, including optional virtual delivery through distance learning, to run through December 31, 2027. CMS also simplified the payment structure to allow both fee-for-service payments for beneficiary attendance and performance-based payments for beneficiary weight loss.
In the CY 2026 PFS Final Rule, CMS updated several policies, including the addition of coverage for asynchronous (online) delivery of the program through December 31, 2029 to increase participation among suppliers and beneficiaries. The final rule clarified that MDPP suppliers are no longer required to maintain in-person delivery sites to allow them to deliver the program online (through December 31, 2029). The rule also finalized a change in weight collection requirements to allow beneficiaries to self-report their weight for MDPP sessions and to permit the submission of weight within five (5) days of a beneficiary’s MDPP session. The final rule also extends flexibilities allowed during the COVID-19 PHE through December 31, 2029.
Model Aims
The MDPP expanded model aims to:
- Prevent or delay the onset of type 2 diabetes in the Medicare population, many of whom may be unaware of their prediabetes status
- Empower high-risk individuals to take action to improve their health
- Achieve cost savings through improved population health
Innovation
Using a unique, evidence-based, CDC-approved curriculum, the MDPP expanded model informs and empowers beneficiaries to make realistic and meaningful behavior and lifestyle changes. Beneficiary participation in the program involves a combination of consistent engagement, accountability, and encouragement, forming the basis for long-term, lasting change. Given the variety of options for how and where to build their new knowledge base, beneficiary choice and agency are cornerstones of the program.
Design
The clinical intervention consists of 16 intensive “core” sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum (called The National Diabetes Prevention Program, or National DPP). It provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control. Suppliers furnish these sessions weekly over six months in a group-based classroom-style setting, in a live virtual distance learning setting, or in a fully asynchronous online format.
After completing the 16 core sessions, beneficiaries attend six monthly follow-up meetings to support their commitment to maintaining healthy behaviors. Suppliers may offer and beneficiaries may attend more than 22 sessions, but Medicare will only pay for up to 22 MDPP sessions per eligible beneficiary.
