Medicare Diabetes Prevention Program (MDPP) Expanded Model

CMS announced July 13, 2023, that it is proposing to extend the rule that allows all MDPP suppliers to use specific MDPP COVID-19 Public Health Emergency (PHE) flexibilities, including the optional virtual delivery of the MDPP set of services through distance learning. The proposed extension of the PHE flexibilities is through December 31, 2027. See the proposed rule fact sheet for more information. 

CMS also proposes to simplify the current performance-based payment structure for MDPP by allowing fee-for-service payments for beneficiary attendance, while keeping the payments for beneficiary weight loss. Additional information regarding the proposed ruling can be found in the Federal Register notice.

Are you a Medicare beneficiary? Please call 1-800-MEDICARE or visit  https://www.medicare.gov/coverage/medicare-diabetes-prevention-program for information about MDPP services.

Looking for a MDPP Supplier? Access the MDPP Supplier Map or view a list of all current MDPP suppliers, along with supplier location information and contact information.

Have Questions about MDPP? Our Frequently Asked Questions page also has answers to key questions about the program. For questions about MDPP and COVID-19, please see the CMS Flexibilities to Fight COVID-19 Frequently Asked Questions (FAQ) (PDF). Several additional resources are provided below to learn about the program.

Want to stay up to date? To sign up for updates about this program, please subscribe to the Medicare Diabetes Prevention Program listserv.

Have questions about CDC Recognition? Visit the National Diabetes Prevention Program Customer Service Center

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Source: Centers for Medicare & Medicaid Services

Highlights

  • Type 2 diabetes affects more than a quarter of Americans aged 65 and older and costs billions to treat each year, numbers that will continue to rise without intervention.

  • The Medicare Diabetes Prevention Program (MDPP) Expanded Model aims to slow this trend by preventing the onset of Type 2 diabetes for people with prediabetes. More specifically, MDPP is a year-long group-based program that provides practical training and education, empowering patients to manage their health.

  • MDPP measures success by monitoring diabetes risk reduction, for example, 5 percent weight loss.

Background

Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. We estimate that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes (estimates based on fee-for-service, non-dual eligible, over age 65 beneficiaries).

Fortunately, type 2 diabetes can usually be delayed or prevented with health behavior changes. The Medicare Diabetes Prevention Program (MDPP) expanded model is a structured behavior change intervention that aims to prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. This model is an expansion of the Diabetes Prevention Program (DPP) model test, which was tested through the Center for Medicare and Medicaid Innovation’s Health Care Innovation Awards.

The final rule establishing the expansion was finalized in the Calendar Year (CY) 2017 Medicare Physician Fee Schedule (PFS) final rule published in November 2016. On November 2, 2017, CMS issued the CY 2018 PFS final rule, which 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 CMS’s 2022 Physician Fee Schedule (PFS) final rule, the agency finalized changes intended to boost MDPP Supplier Enrollment and Medicare beneficiary participation in the MDPP. The proposed rule can be downloaded from the Federal Register, or read the Fact Sheet.

The MDPP Expanded Model

The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing type 2 diabetes in individuals with an indication of prediabetes. The clinical intervention consists of a minimum of 16 intensive “core” sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum furnished over six months in a group-based, classroom-style setting that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control. After the completing the core sessions, less intensive follow-up meetings furnished monthly help ensure that the participants maintain healthy behaviors. The primary goal of the expanded model is at least 5 percent weight loss by participants. The National DPP is based on the results of the Diabetes Prevention Program (DPP) study funded by the National Institutes of Health (NIH). The study found that lifestyle changes resulting in modest weight loss sharply reduced the development of type 2 diabetes in people at high risk for the disease.

To learn more information about approved suppliers enrolling participants near you, visit the MDPP Expanded Model interactive supplier map or view a list of all current MDPP suppliers, including supplier location and contact information.

The final rule appears in the November 2, 2017 Federal Register and can be downloaded from the Federal Register.

Evaluations

Latest Evaluation Reports

Prior Evaluation Reports

Additional Information and MDPP Resources

In regard to any legal question you might have, note that the Medicare Diabetes Prevention Program and the Centers for Medicare & Medicaid Services cannot provide legal advice. You are urged to consult your own legal counsel if you have questions that concern matters of law.

MDPP General FAQs

Opportunities to Get Involved

MDPP Orientation

CDC Recognition and Medicare Enrollment

Medicare Advantage

MDPP Billing and Payment

MDPP Services and Standards

MDPP Fraud and Abuse Waiver

On March 1, 2018 the Office of Inspector General issued a waiver of certain fraud and abuse laws for specified beneficiary engagement incentive arrangements that are part of the MDPP expanded model. The waiver is available on CMS’ Fraud and Abuse Waivers webpage. Although the Centers for Medicare & Medicaid (CMS) provides guidance from time to time on certain aspects of the MDPP, CMS does not provide legal counsel. CMMI is not authorized to comment, formally or informally, on the application of the fraud and abuse waiver to the provision of specific incentives or any arrangements made to provide those incentives. Parties should consult with legal counsel as necessary to ensure that incentives for which they seek waiver protection meet all of the conditions of the waiver.

In regard to questions about avoiding fraud and abuse violations, the Office of the Inspector General has developed free educational resources to help health care providers, practitioners, and suppliers understand the health care fraud and abuse laws and the consequences of violating them. These compliance education materials can also provide ideas for ways to cultivate a culture of compliance within your own health care organization. For additional information on compliance with applicable fraud and abuse laws, please see Fraud and Abuse Law Compliance Resources (PDF). You will also find in that section a link to podcasts prepared by the Health Care Fraud Prevention and Enforcement Action Team (HEAT). In regard to any legal question you might have, note that the Medicare Diabetes Prevention Program and the Centers for Medicare & Medicaid Services cannot provide legal advice. If after reviewing these materials you have additional questions that concern matters of law, we urge you to consult your own legal counsel.

If you have any further questions, please contact us at https://cmsorg.force.com/mdpp/. 

MDPP Regulatory Documents

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