CMS Wants to Change the Medicare Diabetes Prevention Program for the Better
The Medicare Diabetes Prevention Program
(MDPP) is an example of evidence-based LM methods being used to prevent
and delay type 2 diabetes. And CMS is proposing to make the MDPP a lot
easier to navigate, more flexible, and more effective. After receiving
much criticism concerning the MDPP, and after gaining experience during
the COVID-19 PHE, CMS wants to make the MDPP coincide more with the National Diabetes Prevention Program (National DPP).
And if organizations, providing the MDPP, structure their delivery
process using the low-cost, group-based, evidence-based,
DPP-coach-delivery model the National DPP is built on, the organizations
can receive reimbursement that more than covers the cost of delivery
(typically $400.00 to $500.00 per participant).
If the proposed rules are put in place,
CMS will allow DPP virtual delivery, and the pay structure will be
fee-based and value-based. The number of G-codes will be reduced from 15
to 6. There will be one G-code for in-person attendance, and one G-code
for virtual attendance.
The proposed reimbursement amount for an in-person or virtual attendance
will be $25. There will be a G-code for a 5% weight loss, with a
reimbursement payment of $145. If an MDPP participant attends all 22
sessions, the MDPP provider will receive a payment of $550.00. If an
MDPP participant attends all 22 sessions and reaches all weight loss
milestones, the provider will receive $768.00.
There could be changes to the proposals, but because of criticism,
lessons learned during the PHE, and the desire to prevent or delay type 2
diabetes for Medicare beneficiaries, CMS will likely modify the MDPP.
The American Medical Association has been endorsing and promoting the
National DPP for some time. And if you are interested in determining
what might be your cost to deliver the National DPP or the MDPP, you can
use the Budget Tool that the AMA offers.
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posted by Information Uncover at
2:59 PM
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