Since April 2018 Medicare beneficiaries with prediabetes who also have elevated body mass indices (≥ 25 kg/m2 and ≥ 23 kg/m2 in Asian populations) have a benefit with coverage for diabetes prevention services. The coverage is for a year of in-person structured health behavior change sessions (set of services) that use an approved curriculum from the Centers for Disease Control and Prevention. The services can only be provided by programs that are approved Medicare suppliers of the Medicare Diabetes Prevention Program
The MDPP provides opportunities for nutrition and dietetics practitioners to play an important role in diabetes prevention in the Medicare population in health care and community settings. There are various roles for nutrition and dietetics practitioners. The following pages are designed to help you understand the training requirements for MDPP lifestyle coaches, opportunities to integrate MDPP services into the continuum of care for diabetes and increase referrals for Medical Nutrition Therapy and other services, and requirements for becoming a Medicare supplier.
Many private payers already cover diabetes prevention services. The payment methodology, billing codes, and requirements are different for the MDPP.
Medicare uses an Alternative Payment Model that is a performance-based payment methodology for the MDPP services. There are fifteen G codes for the MDPP as well as attendance and weight loss benchmarks to earn maximum payments from the Centers for Medicare and Medicaid Services.
The CDC created the National Diabetes Prevention Program based on the results of the Diabetes Prevention Program Randomized Control Trial. The Centers for Medicare and Medicaid Innovation conducted a DPP model test that demonstrated cost effective risk reduction when lay health workers delivered the CDC-approved curriculum in YMCAs. CMS projects that the MDPP Expanded Model will save $182 million over ten years.
The CDC and CMS are working closely to operationalize the new benefit for Medicare beneficiaries. Each entity has different roles in the MDPP.
Diabetes prevention programs offer an exciting opportunity for RDNs, NDTRs, and other nutrition and dietetics practitioners to create return on investment within their organizations.
For a description of MDPP services, eligibility requirements and beneficiary coverage, as well as steps to become a Medicare supplier of the MDPP.
There are opportunities for nutrition and dietetics practitioners to work in or with diabetes prevention programs and/or to align with Medicare suppliers of the MDPP to build a referral base for MNT and other programs and services.
The role of the trained lifestyle coach is to help participants set goals and solve problems, foster a supportive and respectful group culture, and engage participants. Anyone can become a lifestyle coach.
Programs that meet criteria and enroll as Medicare suppliers for MDPP services are eligible to receive payments from Medicare. Understand the requirements and steps for becoming a Medicare Supplier of the MDPP.
Medicare will make performance-based payments to enrolled Medicare suppliers. The performance based payments are for both attendance and weight loss results.
