National Diabetes Prevention Program Centers for Medicare & Medicaid Service Expansion. Tribal Leaders Diabetes Committee September 22, 2016

Transcription

1 National Diabetes Prevention Program Centers for Medicare & Medicaid Service Expansion Tribal Leaders Diabetes Committee September 22, 2016

2 National Diabetes Prevention Program (DPP) Lifestyle change program designed to prevent type 2 diabetes Key components of the program: CDC-approved curriculum with lessons, handouts, and other resources 16 core sessions (6 months) focusing on: healthy eating, physical activity, and problem-solving strategies for overcoming challenges when changing and sustaining a healthy lifestyle Monthly maintenance sessions (6 months) A lifestyle coach, specially trained to lead the program A support group of people with similar goals and challenges

3 CDC Diabetes Prevention Recognition Program (DPRP) Component of the National Diabetes Prevention Program Purpose: To recognize organizations that have demonstrated their ability to effectively deliver a proven type 2 diabetes prevention intervention To assure quality and provide standardized reporting on performance Based on a set of standards and requirements for recognition Requires an application process and data submission and evaluation to determine eligibility

4 Standards for CDC Recognition Use of a CDC-approved curriculum The ability, capacity, and commitment to: offer the lifestyle program within 6 months of receiving approval from CDC deliver the program over at least 1 year submit data on participants progress including attendance, weight loss, and physical activity every 12 months. Trained lifestyle coaches Diabetes prevention program coordinators

5 Background: CMS Expansion The Centers for Medicare and Medicaid Services (CMS) evaluated outcome data from large pilot DDPs and other CDC DPRPs and determined that DPP is likely to improve quality of care and reduce overall Medicare expenditures if made available to eligible Medicare beneficiaries. Bases of the Proposed Expansion of the DPP Model, referred to as the Medicare Diabetes Prevention Program (MDPP).

6 Proposed MDPP Program Description 12-month program using the CDC approved DPP curriculum DPP organizations must have either preliminary or full CDC recognition status The maintenance sessions are only available to participants if they achieve a 5% weight loss after 6 months into the program. The proposed model allows for a one-time enrollment into the program For the individuals who complete the 12-month program and achieve and maintain the 5% weight loss would be eligible for additional monthly maintenance sessions for as long as the weight loss is maintained.

7 Proposed Beneficiary Eligibility Must be overweight as indicated by: Body Mass Index (BMI) greater than or equal to 25 (greater than or equal to 23 for Asian beneficiaries) Must have pre-diabetes as indicated by the following blood test results (within 12 months prior to the first core session): Hemoglobin A1c of 5.7% to 6.4%; or Fasting plasma glucose of mg/dl; or Two-hour plasma glucose of mg/dl No previous diagnosis of diabetes or End-Stage Renal Disease Gestational diabetes is allowable

8 Proposed Reimbursement Parameters Payment determined by: # of care sessions attended Weight loss of 5% or 9% of baseline weight Maintenance sessions if 5% or greater weight loss maintained

9 Proposed Reimbursement Structure CORE SESSIONS Payment per beneficiary (Non-cumulative) 1 session attended. $25 4 sessions attended $50 9 sessions attended $100 Achievement of minimum weight loss of 5% from baseline weight $160 Achievement of minimum weight loss of 9% from baseline weight $25 (+ $160 above) Maximum Total for Core Sessions $360 MAINTENANCE SESSIONS (MAXIMUM OF 6 MONTHLY SESSIONS OVER 6 MONTHS IN 1 YEAR) 3 maintenance sessions attended (with maintenance of minimum required weight loss from $45 baseline) 6 maintenance sessions attended (with maintenance of minimum required weight loss from $45 baseline) Maximum Total for Maintenance Sessions $90 Maximum Total for First Year $450 MAINTENANCE SESSIONS AFTER YEAR 1 (MINIMUM OF 3 SESSIONS ATTENDED PER QUARTER) 3 maintenance sessions attended + maintenance of minimum required weight loss from baseline $45 6 maintenance sessions attended + maintenance of minimum required weight loss from baseline $45 9 maintenance sessions attended + maintenance of minimum required weight loss from baseline $45 12 maintenance sessions attended + maintenance of minimum required weight loss from baseline $45 Maximum Total After First Year $180

10 September 6, 2016: Key Dates Comments were due regarding the MDPP proposed rule November 2016: CMS will finalize eligibility and enrollment parameters of the proposed rule On or after January 2017: Organizations will be allowed to enroll in MDPP January 2018: MDPP payments will be provided to qualified organizations

11 Thank you Questions?