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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.
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.
The final rule appears in the November 2, 2017 Federal Register and can be downloaded from the Federal Register.
Under the Past Events heading below you will find links Additional Information, including Core Documents about the program, Orientation Materials, Information about Supplier Enrollment and Gaining Recognition, MDPP Services, MDPP Billing and Payment, Information for Medicare Advantage Plans, and FAQs and Guidance. 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. We urge you to consult your own legal counsel if you have questions that concern matters of law. 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. A link to the OIG materials appears below in the FAQs and Guidance section. You will also find in that section a link to podcasts prepared by the Health Care Fraud Prevention and Enforcement Action Team (HEAT).
- Medicare Learning Network Call (12/5/17)
- MDPP Orientation Webinar (12/13/17)
- Listening Session: Medicare Diabetes Prevention Program (MDPP) Expanded Model (08/16/2017)
- Webinar: Medicare Diabetes Prevention Program (MDPP) Expansion: Roles of CMS and CDC (03/22/2017)
- Conference Call: Medicare Diabetes Prevention Program - Expansion Call (11/30/2016)
- Webinar: Medicare Diabetes Prevention Program - Overview (08/09/2016)
MDPP Regulatory Documents
- MDPP Final Rule Fact Sheet - CY2018 PFS (PDF)
- November 2016 Final Rule
- November 2017 Final Rule - CY 2018 PFS (PDF)
- Secretarial Determination Memo (PDF)
- MDPP Overview Fact Sheet
- MDPP Orientation Roadmap
- MDPP Orientation Video
- MDPP CDC - CMS Roles Fact Sheet (PDF)
- MDPP Blog
MDPP Enrollment and Recognition Information
- MDPP interactive supplier map
- MDPP Enrollment Fact Sheet (PDF)
- MDPP Enrollment Checklist (PDF)
- MDPP Enrollment Application (PDF)
- MDPP Enrollment Process Timeline (PDF)
- MDPP Interim Preliminary Recognition Process
- Updated Guidance about List of MDPP Organizations with Interim Preliminary Recognition (PDF)
- Frequently Asked Questions
- Conference Call: MDPP Expanded Model - Supplier Enrollment (06/20/2018)
- Guidance for Medicare Advantage Plans from 2018 CY 2018 PFS (PDF)
- Fact Sheet - Medicare Advantage (PDF)
MDPP FAQs and Guidance
MDPP Billing and Payment
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. For additional information on compliance with applicable fraud and abuse laws, please see Fraud and Abuse Law Compliance Resources (PDF).
If you have any further questions, please contact the MDPP Help Desk at 1-877-906-4940 or email email@example.com.