Determining the Medicaid Enrolled Provider Type
Who Will Provide National DPP Lifestyle Change Program Services?
State Medicaid agencies must decide who will deliver the National Diabetes Prevention Program (National DPP) lifestyle change program to Medicaid beneficiaries. States have two options: they can use an existing provider type to deliver the program or they can create a new provider type. It is possible for states to pursue both options at the same time or to pursue one approach first and another approach at a later date.
Delivery of the National DPP lifestyle change program requires both Medicaid billing and rendering providers. Both types of providers need a National Provider Identifier (NPI), but billing providers are reimbursed by Medicaid and rendering providers facilitate the National DPP lifestyle change program sessions. For example, the billing provider could be the CDC-recognized organization and the rendering provider could be the lifestyle coach, or the billing provider could be a health system (clinic or hospital) and the rendering provider could be a CDC-recognized organization.
Whether Medicaid is using an existing provider type or creating a new provider type, the Medicaid agency will have to determine the mode of delivery for the National DPP lifestyle change program: in-person, online, distance learning, and/or combination.
Click a button below to learn more about using an existing provider type or creating a new provider type.
Content last updated: October 3, 2019