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CMS BLOG
April 30, 2018
By CMS Administrator Seema Verma
CMS Encourages
Eligible Suppliers to Participate in Expanded Medicare Diabetes Prevention
Program Model
Nationally expanded
performance-based payment model now enrolling service suppliers
The Centers for
Medicare & Medicaid Services (CMS) in April expanded the Medicare Diabetes Prevention Program
(MDPP), a
national performance-based payment model offering a new approach to type 2
diabetes prevention in eligible Medicare beneficiaries with an indication
of pre-diabetes. For the first time, both traditional healthcare providers
and community-based organizations can enroll as Medicare suppliers of
health behavior change services. This innovative model promotes
patient-centered care and continues to test market-driven reforms to drive
quality of care and improve outcomes for America’s seniors, more than a
quarter of whom have type 2 diabetes.
CMS recognizes
that prevention is a critical part of creating an affordable healthcare
system that puts patients first, and we encourage eligible suppliers to
partner with us on this shared goal by participating in the national
expansion of the MDPP.
As the CMS
Innovation Center’s first preventive services model test to expand
nationally, the MDPP is a key example of how we’re putting innovation to
work. The model launched in 2012 as a small, voluntary model test at 17
sites across the country in partnership with the YMCA-USA, Centers for
Disease Control and Prevention (CDC), and other public and private
partners. Now, CMS is expanding this set of services nationwide based on
promising results. In the initial model test, 45 percent of beneficiaries
met the 5 percent weight loss target, which translates to a clinically
meaningful reduction in the risk of developing type 2 diabetes.
Through the MDPP,
trained community health workers and other health professionals empower
beneficiaries at high risk of developing type 2 diabetes to take ownership
of their health through curriculum-driven coaching and proven behavior
change strategies for weight control. As a new preventive service for
qualifying Medicare beneficiaries, MDPP services are available without a
referral or co-payment.
The MDPP is not
only a good value for our beneficiaries. Investing in prevention through
performance-based payments and market-based incentives, this promising
model will save the Medicare program more than $180 million by keeping
beneficiaries healthy and averting new cases of diabetes[i].
One of the
critical innovations in the MDPP is its approach to care delivery: For the
first time, community-based organizations can enroll in Medicare to provide
evidence-based diabetes prevention services after achieving preliminary or
full recognition through the CDC. These organizations can enroll in
Medicare to become an MDPP Supplier today, and CMS will continue to accept
supplier applications on a rolling basis. Eligible organizations can begin
the screening and enrollment process to become an MDPP Supplier by using
the Provider Enrollment Chain and Ownership System (PECOS) or submitting
the paper CMS-20134 Form. For information on the steps to enrollment,
please refer to the MDPP Enrollment Fact Sheet.
Diabetes exerts
an unacceptable toll on our beneficiaries, their families, and the Medicare
program, which spends more than $104 billion every year treating patients
with this preventable disease. The Medicare Diabetes Prevention Program is
leveraging innovation to bring valuable preventive services to our
beneficiaries, and I urge eligible organizations across the country to enroll
today in this exciting performance-based payment opportunity.
[i] Federal Register. Department of
Health and Human Services, Centers for Medicare and Medicaid Services. Medicare
Program; Revisions to Payment Policies Under the Physician Fee Schedule and
Other Revisions to Part B for CY 2018; Medicare Shared Savings Program
Requirements; and Medicare Diabetes Prevention Program; Final Rule.
November 15, 2017. [pg. 53355 – 53356] https://www.gpo.gov/fdsys/pkg/FR-2017-11-15/pdf/2017-23953.pdf
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