Commercial Payers → Fiscal Operations → Contracting with CDC-Recognized Organizations
Contracting with CDC-Recognized Organizations
Contracts between the commercial health insurance plan or employer and CDC-recognized organizations should outline expectations between the parties and include National Diabetes Prevention Program (National DPP) lifestyle change program requirements.
CDC-recognized organizations are those that have demonstrated the ability to effectively deliver the evidence-based lifestyle change program with quality and fidelity as described in CDC’s Diabetes Prevention Recognition Program (DPRP) Standards. For more information, see the Standards for CDC Recognition.
Some common elements recommended for inclusion in contracts between the commercial plan or employer and CDC-recognized organizations include:
- Program eligibility requirements
- Description of covered services
- Program promotion and enrollment expectations
- Reimbursement schedule and billing codes (if applicable)
- CDC-recognition requirements
- Data sharing and reporting expectations
- Patient data confidentiality language
The document below includes language related to these prospective contract elements. It is intended to be educational in nature, providing elements to consider when contracting between a commercial payer (Payer) and a CDC-recognized organization (Organization). Entities should consult with an attorney or contract specialist when establishing such an agreement.
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Note: Commercial plans may require CDC-recognized organizations to also enter into a Business Associate Agreement (BAA). For more information about a BAA and other data sharing requirements, see Data & Reporting.
Other Considerations
Other considerations may include the amount of time it takes to contract with these organizations in view of each organization’s capacity to manage the contracting process and their access to legal counsel. Additional considerations related to contracting, including network management and identifying CDC-recognized organizations, are included in the Delivery section.
As an alternative to contracting directly with CDC-recognized organizations, some commercial plans or employers may choose to contract with a third-party organization to administer the lifestyle change program. Third-party organizations can work with commercial plans or employers to establish a network of CDC-recognized organizations, work with health care providers, and recruit eligible individuals into the program. For example, commercial payers and employers can tap into a network of CDC-recognized organizations called an umbrella hub arrangement (UHA), which connect organizations with health care payment systems to pursue sustainable reimbursement for the National DPP lifestyle change program.
