Type 2 Diabetes is Preventable
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The National DPP
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Participating Payers
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Medicaid
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MCO
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Commercial Payers
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Medicare
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Sustainability
National DPP Overview
Read more about the National DPP, the prevalence of diabetes, the CDC’s Diabetes Prevention Recognition Program, CDC-recognized organizations, and the National DPP lifestyle change program.
Evidence
This section provides information and resources on research studies and evaluations that have repeatedly shown that the National DPP lifestyle change program improves health outcomes and is cost-effective or cost-saving.
Cost & Value
When considering coverage of the National DPP lifestyle change program, many public and private payers weigh the costs of covering the program for their employees or members with the value they could achieve. This page explores the key concepts related to creating a value proposition for covering the program as well as the evidence and tools available to help organizations substantiate the benefits of preventing or delaying type 2 diabetes.
Timeline
Translational studies, large-scale program implementations, and decisions by public and commercial payers to cover prevention programs have evolved the understanding of and access to the National DPP lifestyle change program. This section presents a twenty-year timeline of that history.
Quality Metrics
While there is currently not a prediabetes-focused quality measure, other metrics exist and can be used to help ensure that prediabetes screening activities drive participation into programs leading to a decrease in the prevalence of type 2 diabetes.
Curriculum
This page includes links to the available PreventT2 National Diabetes Prevention Program curricula. Curriculum resources are available in the following languages: Arabic, Bengali, Chinese, Chuukese, English, Haitian-Creole, Korean, Kosraean, Marshallese, Portuguese, Spanish, and Vietnamese.
Additional Initiatives
A key aspect of sustaining the National DPP lifestyle change program is generating stakeholder and community support. States should leverage existing resources in building this support. This section provides information and links to these additional initiatives
Participating Payers
This page describes payers that are covering the National DPP lifestyle change program. Payers include commercial health plans, private employers, public employers, state Medicaid, and Medicare.
Medicaid Coverage
Offering the National DPP lifestyle change program as a Medicaid covered benefit is the ideal vehicle to sustain the program financially. This section provides information on ways state Medicaid funds and federal Medicaid funding can be claimed for the program, how to determine the Medicaid enrolled provider type for the program, and state stories highlighting the pathways states have taken to cover the program.
Medicaid Demonstration
This section describes the Medicaid Coverage for the National DPP Demonstration Project, a multi-year project carried out in Maryland and Oregon that was managed by NACDD and funded by CDC. The purpose of the Demonstration was to show how state Medicaid agencies and state health departments can collaborate to implement, deliver, and sustain coverage of the National DPP lifestyle change program.
Medicaid Case for Coverage
This section is written for public health professionals to provide guidance for working with their Medicaid colleagues to make the case to cover the National DPP lifestyle change program.
Medicaid Delivery
This section provides information on steps Medicaid agencies should consider in offering the National DPP lifestyle change program. It also discusses practices that have been implemented in Medicaid and other contexts to enhance National DPP lifestyle change program delivery.
Medicaid and MCO Reimbursement
This section provides information on various program costs, reimbursement models, and how to consider these costs in rate-setting processes.
Coding & Billing
This section includes information on the steps and considerations associated with coding and billing for the National DPP lifestyle change program, including the ICD and CPT codes currently being used for the program and a summary of their general operations.
Data, Reporting, and Evaluation
This section provides information on the type of data that needs to be reported to CDC’s Diabetes Prevention Recognition Program (DPRP), information on Medicaid data and reporting standards, and information on compliance issues and standards.
MCO Coverage
This page describes the dynamic and flexible role managed care organizations (MCOs) can play in promoting coverage of the National DPP lifestyle change program in Medicaid.
Medicaid Demonstration
This section describes the Medicaid Coverage for the National DPP Demonstration Project, a multi-year project carried out in Maryland and Oregon that was managed by NACDD and funded by CDC. The purpose of the Demonstration was to show how state Medicaid agencies and state health departments can collaborate to implement, deliver, and sustain coverage of the National DPP lifestyle change program.
MCO Delivery
This section provides information on steps Medicaid MCOs should consider in offering the National DPP lifestyle change program. It also discusses practices that have been implemented in Medicaid and other contexts to enhance National DPP lifestyle change program delivery.
Medicaid and MCO Reimbursement
This section provides information for MCOs and Medicaid agencies on program costs, reimbursement models being used by other states, and information on how the program impacts the medical loss ratio.
MCO Contracting
This section provides information on how to incorporate references to the National DPP lifestyle change program into state MCO contracts and CDC-recognized organization contracts and provides sample contract components
Coding & Billing
This section includes information on the steps and considerations associated with coding and billing for the National DPP lifestyle change program including the ICD and CPT codes currently being used for the program and a summary of their general operations.
Data, Reporting, and Evaluation
This section provides information on the type of data that needs to be reported to CDC’s Diabetes Prevention Recognition Program (DPRP), information on Medicaid data and reporting standards, and information on compliance issues and standards.
Coverage in Practice
This page describes how commercial payers typically cover the National DPP lifestyle change program. It provides examples of organizations that are currently covering the program and some suggested best practices.
Commercial Payers Case for Coverage
This section is written for commercial health plans and employers to help make the case to cover the National DPP lifestyle change program.
Commercial Payers Delivery
This section provides information on steps commercial plans and employers should consider in offering the National DPP lifestyle change program. It also discusses practices that have been implemented in commercial plan and employer contexts to enhance National DPP lifestyle change program delivery.
Commercial Payers Reimbursement
This section provides information for commercial health insurance plans and employers on program costs, reimbursement models, and information on how the program impacts the medical loss ratio.
Commercial Payers Contracting
This section provides sample contract components for contracts between commercial payers and CDC-recognized organizations.
Coding & Billing
This section includes information on the steps and considerations associated with coding and billing for the National DPP lifestyle change program, including the ICD and CPT codes currently being used for the program and a summary of their general operations.
Data, Reporting, and Evaluation
This section provides information on the type of data that needs to be reported to CDC’s Diabetes Prevention Recognition Program (DPRP), information on data and reporting standards used by commercial plans and employers, and information on compliance issues and standards.
MDPP Basics
This page offers an overview of Medicare Diabetes Prevention Program (MDPP) basics, including a summary of MDPP services, beneficiary eligibility criteria and referrals, supplier eligibility and enrollment, reimbursement, and information on Medicare Advantage plans.
MDPP Implementation Resources
This section serves as a repository of webinars and resources to inform and assist MDPP suppliers with program implementation and sustainability. Webinar and resource topics include referrals and recruitment, marketing, promoting the MDPP during the public health emergency (PHE), working with Medicare Advantage (MA) plans, and billing and claims.
Umbrella Hub Arrangements
Umbrella hub arrangements (UHAs) connect community-based organizations (CBOs) with health care payment systems to pursue sustainable reimbursement for the National DPP lifestyle change program. This section presents the case for creating a UHA and shares learnings from the Umbrella Hub Demonstration.
Health Equity
This section focuses on health equity in the context of the National DPP lifestyle change program: how promoting health equity can support the impact of the program, and how the program itself can be used as a tool and a model to promote health equity.
Engaging ACOs
This page is intended to provide National DPP stakeholders with information about Accountable Care Organizations (ACOs) and specific strategies for how to engage ACOs in the effort to prevent type 2 diabetes.
Engaging FQHCs
Federally Qualified Health Centers (FQHCs) are comprehensive, community-based primary care providers that offer affordable care in areas with high need for health care. This page focuses on Medicaid and Medicare reimbursement of FQHCs delivering the National DPP lifestyle change program.
Engaging Pharmacists
Pharmacists and pharmacy staff can play a key role in scaling the National DPP lifestyle change program. This page provides resources, strategies, and examples for engaging pharmacies in identifying eligible patients, referring and enrolling patients in the National DPP lifestyle change program, or becoming CDC-recognized organizations.
Building Network Capacity
This page provides information and examples for how state agencies can assess the landscape and technical assistance needs of CDC-recognized organizations, expand the capacity of the state network through support of existing and recruitment of new organizations, help organizations develop business acumen skills for successfully engaging with payers, and explore options for providing third-party or collective administrative support.
Communicating the Benefit
Achieving Medicaid coverage of the National DPP lifestyle change program is an important milestone towards reducing the prevalence of type 2 diabetes in a state. To facilitate uptake of the benefit, states are encouraged to leverage a variety of communication and promotion strategies to generate enthusiasm, buy-in, and engagement with the benefit. This page describes approaches that states have taken to communicate and promote the benefit.
The Coverage Toolkit General Overview video below is a virtual overview of the National DPP Coverage Toolkit and includes a description of how the website is organized, suggests ways to navigate through the pages, and highlights various tools and sections in order for visitors to get the most use from this online resource.
The National DPP Coverage Toolkit was supported by the Grant or Cooperative Agreement Number 5NU38OT000225-04, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
