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February 1, 2018

Medicare Diabetes Prevention Program Enrollment News

On November 2, 2017, the Centers for Medicare & Medicaid Services issued the Calendar Year (CY) 2018 Physician Fee Schedule (PFS) final rule, which finalizes policies to implement the Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018. The expanded model is a structured intervention with the goal of preventing progression of type II diabetes in individuals with an indication of pre-diabetes. The CY 2018 PFS includes the MDPP payment structure as well as enrollment requirements and supplier compliance standards.

The MDPP expanded model includes an evidence-based set of services aimed to help prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. MDPP services will be available to eligible beneficiaries nationwide beginning April 1, 2018 under a performance-based payment model through the CMS Innovation Center.  Organizations who wish to furnish MDPP services to beneficiaries and bill Medicare for those services must enroll in Medicare as an MDPP supplier.

To enroll as an MDPP supplier, organizations must:

  • Have MDPP preliminary recognition or full CDC DPRP recognition
  • Have an active and valid tax-identification number (TIN) or national provider identifier (NPI)
  • Pass enrollment screening at the high categorical risk level
  • On the MDPP enrollment application, submit a list of MDPP coaches who will lead sessions, including full name, date of birth, social security number (SSN), and active and valid NPI and coach eligibility end date (if applicable)
  • Meet MDPP supplier standards and requirements, and other requirements of existing Medicare providers or suppliers
  • Revalidate its enrollment every 5 years

MDPP suppliers can now enroll through a new MDPP Specific FormExternal PDF.  CMS has issued a MDPP Enrollment Fact SheetExternal PDF and a MDPP Enrollment ChecklistExternal PDF to assist MDPP suppliers.

References
CMS MDPP Web Page External Website
MDPP Supplier Journey Roadmap External Website
CMS/CDC Roles Fact SheetExternal PDF
MDPP Fact SheetExternal PDF
Medicare Diabetes Prevention Program (MDPP) Model Expansion Call PresentationExternal PDF
Final RuleExternal Website

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