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Final Medicare DPP Rule Adjusts Maintenance Period, Excludes Digital Providers

Mary Caffrey

CMS has agreed to limit the maintenance period of the Medicare Diabetes Prevention Program (DPP) to reduce burdens and financial risk on providers, but regulators did not budge on other key concerns when they finalized the program rule late Thursday.

Medicare DPP will launch April 1, 2018, more than 2 years after former HHS Secretary Sylvia Mathews Burwell announced that a pilot by the Center for Medicare and Medicaid Innovation (CMMI) had shown the DPP would save $2650 per beneficiary over 15 months. An estimated 84 million Americans have prediabetes, including 22 million age 65 years and older.

“Yesterday CMS released the Medicare Diabetes Prevention Program final rule which will guide the implementation of the Medicare DPP services next year. It is clear that CMS has closely listened to stakeholder feedback in several areas, including alignment and greater clarity for Medicare Advantage, which is now confirmed to start on April 1, 2018,” said Brenda Schmidt, CEO of Solera Health.

The DPP is a yearlong, evidence-based lifestyle change program with a CDC-approved curriculum. The original program featured 16 weekly core sessions followed by 7 monthly sessions. Evidence shows the program stops prediabetes from progressing as participants make modest changes and lose 5% to 7% of body weight. In a landmark study by the National Institutes of Health, the program showed a 58% reduction in participants progressing to diabetes.

But as seen in the rulemaking process, what passes muster with CDC for efficacy with patients and what’s needed to prevent fraud with Medicare are not the same. Providers that today offer DPP through community groups and employers have raised concerns that CMS is creating so many barriers—without enough compensation—that many successful programs will pass on Medicare DPP.

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