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The Medicare Diabetes Prevention Program Expanded Model


7/28/2017

This year’s recently released Physician Fee Schedule (PFS) Proposed Rule included additional proposals to implement the Medicare Diabetes Prevention Program (MDPP) expanded model that would start in 2018. This proposal opens up major opportunities for occupational therapy practitioners working under the umbrella of MDPP organizations that have either preliminary or full Centers for Disease Control and Prevention (CDC) recognition status; these entities are subsequently classified as MDPP “suppliers.” Following this procedural step, MDPP suppliers are then required to submit the active and valid national provider identifiers (NPIs) of all Certified Diabetes Prevention health coaches who intend to furnish MDPP services. Huge potential exists in this model to demonstrate the value of OT services when it comes to potentially lowering the rate of progression of Type 2 diabetes, while improving patients’ overall health at a reduced cost. Through the expansion of this model test, Medicare beneficiaries are looking at greater access to diabetes prevention services.

This model is a clinical intervention that consists of a minimum of 16 intensive “core sessions” of a CDC-approved curriculum. The sessions are furnished over 6 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. Following the core sessions, less intensive follow-up meetings occur in order to help ensure maintenance of the healthy behaviors learned throughout the program. Services provided under this model are largely furnished in person, with the primary goal of having participants achieve at least a 5% weight loss. Because weight loss is viewed as a key indicator of success among individuals enrolled in a diabetes prevention program, the proposed payment structure values this factor most significantly. 

The PFS proposes additional policies necessary for suppliers to begin providing MDPP services nationally in 2018. Some of these policies include the MDPP payment structure, as well as additional supplier enrollment requirements and supplier compliance standards aimed to ensure program integrity. It is important to point out that MDPP services would be billed by the MDPP supplier, and not by an individual clinician. The Centers for Medicare & Medicaid Services (CMS) has also developed an MDDP Fact Sheet with more details.  

AOTA will be commenting on the MDPP expanded model and other policies within its Physician Fee Schedule comment letter. We are always looking to hear about members’ experiences in these new innovative health delivery models that expand opportunities for current and future practitioners. If you are a Certified Diabetes Prevention health coach furnishing services on behalf of an MDPP supplier, please contact us by September 1, 2017 at regulatory@aota.org to share your experiences.