Glossary of Terminology

0403T and 0488T Codes = Current Procedural Terminology (CPT) Category III codes used by CDC-recognized organizations to bill for nonclinical National DPP lifestyle change program services. Category III codes are temporary codes used to track emerging technologies, services, and procedures.

• 0403T is used for in-person sessions and can be billed once per day.
• 0488T is used for online delivery and may be billed once every 30 days.

These codes are intended for individuals with prediabetes and should not be used for individuals with diagnosed diabetes.

A1C test (or HbA1c) = A blood test that measures an individual’s average blood sugar level over the past three months. Unlike daily blood sugar checks used to manage diabetes, the A1C test is commonly used to diagnose prediabetes and diabetes. An A1C level of 5.7% and 6.4% indicates prediabetes, while a level of 6.5% or higher indicates diabetes.

Accountable care organization (ACO) = A group of health care providers who work together to coordinate care for a defined group of patients. ACOs are responsible for improving quality while managing the total cost of care and are one of the most common value-based payment models.

ADA-recognized = A designation indicating that a diabetes self-management education and support (DSMES) program has been reviewed and approved by the American Diabetes Association (ADA) as meeting national quality standards. The Centers for Medicare and Medicaid Services (CMS) authorized both the ADA and the Association of Diabetes Care and Education Specialists (ADCES) to serve as national accrediting bodies for DSMES.

ADCES-accredited = A designation indicating that a diabetes self-management education and support (DSMES) program has been reviewed and approved by the Association of Diabetes Care and Education Specialists (ADCES) as meeting national quality standards. The Centers for Medicare and Medicaid Services (CMS) authorized both the American Diabetes Association (ADA) and ADCES to serve as national accrediting bodies for DSMES.

Alternative Payment Model (APM) = A payment approach that rewards health care providers for delivering high-quality, cost-effective care instead of paying based on the number of services provided. APMs may focus on a specific clinical condition, episode of care, or patient population. One example is a bundled payment, in which a single payment covers all related services for a defined episode of care.

Braiding and layering funding = An approach that combines funding from multiple sources to support a shared program or goal. Braiding keeps each funding source separate while coordinating how the funds are used. Layering funding – sometimes referred to as “blending” – pools multiple funding sources into a single funding stream.

Budget neutral = A requirement for Section 1115 demonstrations stating that federal Medicaid spending during the waiver period cannot exceed what the federal government would have spent if the waiver had not been approved.

Bundled payment = A form of value-based payment in which providers are paid a single, comprehensive amount for treating a specific condition or episode of care, rather than being reimbursed for each service separately.

Capitation = A value-based payment model in which a health care provider or health plan receives a fixed amount of money per enrolled member for a set period (usually per month) to provide or arrange covered health care services, regardless of how many services the member uses.

CDC-recognized organization = An organization that offers the National DPP lifestyle change program and has received recognition from CDC’s Diabetes Prevention and Recognition Program (DPRP). CDC recognizes organizations that meet certain standards and show they can achieve results. These standards include following an approved curriculum, facilitation by a trained Lifestyle Coach, and submitting data every six months to show that the program is having an impact.

Centers for Disease Control and Prevention (CDC) = The federal public health agency within the U.S. Department of Health and Human Services (HHS). CDC works for protect the nation’s health by preventing and controlling disease, promoting healthy behaviors, responding to public health threats, and advancing health through research, education, and partnerships.

Centers for Medicare and Medicaid Services (CMS) = The federal agency within the U.S. Department of Health and Human Services that administers Medicare and works with states to oversee Medicaid and Children’s Health Insurance Program (CHIP).

Churn = The movement of individuals in and out of health insurance coverage or between health plans, often due to changes financial, employment, or residential status.

CMS’ Preventive Services Rule = A rule issued by CMS in 2014 that allows state Medicaid programs to reimburse for preventive services provided by qualified professionals who may not be licensed clinicians, as long as the services are recommended by a physician or other licensed practitioner.

Cohort = A group of participants enrolled in a National DPP lifestyle change program. A completed cohort has a defined start and end date and runs for 12 months. A CDC-recognized organization may have multiple cohorts running at the same time and may have a mix of participants covered by different payers.

Collective impact = A collaborative approach in which organizations and community partners work together toward a common goal through shared planning, learning, and coordinated action.

Community-based organization (CBO) = Public or not-for-profit entity that provides services and support to people in a community.

Community care hub (CCH) = A community-based organization (CBO) that coordinates and supports a network of CBOs to deliver evidence-based health programs, connect people to community resources, and address health-related social needs (HRSN).

Community Health Integration (CHI) services = Medicare-covered services that help people with one or more serious chronic conditions address health-related social needs (HRSN) and connect to community resources through care coordination, system navigation, and person-centered support.

Community health worker (CHW) = Frontline public health workers who are trusted members of the communities they support. Also known as community health representatives, promotores de salud, and community health advisors, CHWs connect community members to health care systems and social services by helping individuals access care, navigate programs, and build skills to manage their health.

Current Procedural Terminology (CPT) = A standardized set of medical billing codes set used to describe health care services and procedures for billing, reporting, and reimbursement. The American Medical Association develops and maintains CPT codes.

• CPT Category I Codes = Permanent five-digit codes used to report established medical procedures or services.
• CPT Category II Codes = Optional tracking codes used to measure quality of care and performance.
• CPT Category III Codes = Temporary codes used to track emerging technologies, services, and procedures as they are evaluated for broader use.

Customer Service Center = The CDC’s National DPP Customer Service Center provides organizations with access to a wide range of resources – including training materials, toolkits, and videos – to support the delivery of the National DPP. Users can also ask questions and receive technical assistance on all aspects of the program.

Diabetes care and education specialist = A health care professional with expertise in diabetes care, education, and behavior change who helps people prevent and manage diabetes by providing education, developing self-management skills, and supporting healthy lifestyle changes.

Diabetes self-management education and support (DSMES) = An evidence-based program that helps people with diabetes learn the skills needed to manage blood sugar, make healthy lifestyle changes, foster healthy coping strategies, and prevent or delay complications.

Diabetes self-management program (DSMP) = An evidence-based, community-based workshop developed by Stanford University that helps people with diabetes build the skills and confidence to manage their condition through goal setting, problem solving, and peer support.

Diabetes self-management training (DSMT) = The term Medicare uses for covered diabetes self-management education and support (DSMES).

Delivery System Reform Incentive Payment (DSRIP) = A Medicaid program authorized through a Section 1115 demonstration, that provides funding to health care providers and health plans for implementing projects that improve care delivery, payment models, and health outcomes.

Diabetes Action Plan = Legislation that establishes a coordinated approach among state agencies to reduce the burden of diabetes. It brings together agencies such as the state Medicaid agency, state health department, and the agency responsible for state employee health benefits to develop and implement strategies for diabetes prevention and management.

Diabetes incidence = The number of new cases of diabetes that occur in a population during a specific period of time.

Diabetes Prevention Program (DPP) = A landscape research study published in 2002 that showed modest lifestyle changes, including healthy eating, increased physical activity, and weight loss could reduce the risk of developing type 2 diabetes by 58% in adults with prediabetes (71% for adults age 60 and older).

Diabetes Prevention Recognition Program (DPRP) = The CDC program that sets the national standards for the National DPP lifestyle change program and recognizes organizations that meet those standards. The DPRP monitors program quality and participant outcomes to help ensure the program is delivered with fidelity to the evidence-based model.

DPP Business Tools: An online resource that offers operational and financial planning resources designed for CDC-recognized organizations, umbrella bub organizations (UHOs), and state health departments to model scenarios and forecast outcomes. Available tools include revenue projection, participant enrollment planning, organizational capacity assessment, and UHO capacity assessment.

Dual eligible = A person who is eligible for both Medicare and Medicaid. Medicare is the primary payer, and Medicaid helps cover eligible costs that Medicare does not pay.

Electronic clinical quality measures (eCQM) = A standard quality measurement format that uses information from electronic health records (EHRs) and other health information technology systems to assess the quality of health care.

Electronic health record (EHR) = A digital version of a person’s medical record that authorized health care providers and staff can securely access, update, and share to support patient care.

Fasting plasma glucose = A blood test taken after fasting that measures blood sugar levels. It is commonly used to help diagnose prediabetes and diabetes.

Family healthy weight program (FHWP) = An evidence-based program for children and their families that promotes healthy eating, physical activity, and behavior changes to improve health and reduce the risk of obesity and related health conditions.

Federally Qualified Health Center (FQHC) = A community health center that receives federal funding to provide comprehensive primary care services to medically underserved communities, regardless of a person’s ability to pay.

Fee schedule = A list that shows how much a health plan or payer will pay for specific health care services. The services are identified using standardized medical billing and diagnosis codes, such as CPT and ICD-10.

Food is Medicine (FIM) = An approach that uses nutritious foods to help prevent, manage, or treat diet-related health conditions. Common FIM interventions include medically tailored meals, medically tailored groceries, and produce prescriptions.

Gestational diabetes (GDM) = A type of diabetes that develops during pregnancy in people who did not already have diabetes. It usually goes away after pregnancy but increases the risk of developing type 2 diabetes later in life.

Healm = An online platform that includes proprietary decision-making software, a personalized progress tracking and metrics dashboard, and tailored technical assistance.

Healthcare Effectiveness Data and Information Set (HEDIS) = A standardized set of quality measures developed by the National Committee for Quality Assurance (NCQA) and used by most U.S. health plans to evaluate the quality of care and services they provide. The measures assess areas such as preventive services, chronic disease management, and population health.

Health Insurance Portability and Accountability Act (HIPAA) = Legislation that provides data privacy and security provisions for safeguarding medical information.

Health-related social needs (HRSN) = An individual’s immediate social and economic needs that affect their health, such as food insecurity. These needs are influenced by broader social determinants of health (SDOH).

In lieu of services and settings (ILOS) = A Medicaid managed care option that allows plans to cover alternate services or settings instead of those covered under the Medicaid State Plan, when they are medically appropriate and cost-effective. ILOS can improve access to care, address health-related social needs, and support better health outcomes.

Incremental cost-effectiveness ratio (ICER) = A measure used to compare the costs and health benefits of two interventions. It shows the additional cost required to achieve one additional unit of health benefit when choosing one intervention over another.

International Classification of Diseases (ICD-10) = A standardized system of diagnosis codes used by health care providers to classify diseases, conditions, injuries, and other health problems for documentation, billing, and reporting.

Lifestyle Coach = A person trained by a CDC-approved training organization to deliver the National DPP lifestyle change program using a CDC–approved curriculum. Lifestyle Coaches may have clinical or nonclinical backgrounds. They lead program sessions, encourage and support participants, and help collect and report program data.

Medicaid = A government health insurance program jointly funded by the federal government and states that provides health coverage for eligible low-income individuals and families, including children, pregnant women, older adults, and people with disabilities.

Medicaid Coverage for the National DPP Demonstration Project = A CDC-funded and NACDD-led project launched in to test how state Medicaid programs could provide coverage for the National DPP lifestyle change program through Medicaid managed care organizations (MCOs) and accountable care organizations (ACOs). To learn more, visit the Medicaid Coverage for the National DPP Demonstration Project page of the Coverage Toolkit.

Medicaid enrolled provider = A qualified health care provider or organization that is enrolled in a state Medicaid program and can bill Medicaid for covered services provided to eligible beneficiaries.

Medicaid federal match = The federal government’s share of Medicaid costs. States receive federal matching funds for covered Medicaid services and certain administrative costs. The federal matching rate varies by state and generally falls within 50-80% of a state’s Medicaid costs.

Medicaid managed care organization (MCO) = A health insurance plan that contracts with a state Medicaid agency to deliver health care services to Medicaid beneficiaries. MCOs receive a fixed payment for each enrolled member (called a per member per month, PMPM, payment) to provide and coordinate covered services.

Medicaid Management Information System (MMIS) = A state’s computer system that supports Medicaid operations, including provider enrollment, claims processing, payment, and reporting.

Medicaid State Plan = An agreement between a state and the federal government that describes how the state’s Medicaid program operates, including who is covered, what services are provided, and how providers are paid.

Medical Loss Ratio (MLR) = The percentage of health insurance premium dollars a health plan spends on health care services and activities that improve health care quality, rather than on administrative costs or profits.

Medically tailored groceries/meals = Food is Medicine (FIM) interventions that provide grocery items and/or prepared meals designed to meet a person’s specific medical and nutritional needs based on their health condition.

Medicare = The federal health insurance program that provides coverage for people age 65 and older, certain younger people with disabilities, and people with End-Stage Renal Disease, regardless of age.

Medicare Access and CHIP Reauthorization Act (MACRA) = A federal law enacted in 2015, that established a new approach to paying physicians and other eligible clinicians under Medicare Part B. MACRA promotes value-based care through programs such as the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

Medicare Administrator Contractor (MAC) = A private company that contracts with Medicare to process provider enrollment, pay Medicare fee-for-service claims, and perform other administrative functions in a designated geographic area.

Medicare Advantage (MA) = A Medicare-approved private health plan that provides hospital and medical coverage under Medicare Parts A and B (sometimes called “Part C” or “MA Plans”). Medicare pays the plan a set amount each month for every enrolled member.

Medicare Diabetes Prevention Program (MDPP) = A Medicare Part B preventive benefit that provides eligible beneficiaries with access to the National DPP lifestyle change program to help prevent or delay type 2 diabetes. CDC-recognized organizations must enroll as an MDPP supplier to deliver the program and receive Medicare reimbursement.

Medicare Diabetes Prevention Program (MDPP) supplier = A CDC-recognized organization that is enrolled in Medicare to provide the MDPP and receive Medicare reimbursement. Organizations must have CDC preliminary, full, or full plus recognition.

Medicare Merit-Based Incentive Payment System (MIPS) = A Medicare quality reporting and payment program for eligible health care providers. Performance is evaluated across several categories, including quality, use of health information technology, and practice improvement activities. Medicare payment is adjusted based on the health care provider’s overall score.

National Association of Chronic Disease Directors (NACDD) = The National Association of Chronic Disease Directors (NACDD) and its more than 7,000 Members seek to strengthen state-based leadership and expertise for chronic disease prevention and control in states and nationally. Established in 1988, in partnership with the CDC, NACDD is the only membership association of its kind to serve and represent every chronic disease division in all states and U.S. territories.

National Committee for Quality Assurance (NCQA) = An independent non-profit organization in the U.S. that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation.

National Diabetes Prevention Program (National DPP) = A partnership of public and private organizations working collectively to establish, scale, and sustain an evidence-based lifestyle change program for people with prediabetes to prevent or delay onset of type 2 diabetes.

National DPP lifestyle change program = A CDC-recognized, year-long program based on the original Diabetes Prevention Program (DPP) research study. The program is led by trained Lifestyle Coaches, uses a CDC-approved curriculum, and helps participants build healthy habits through healthy eating, physical activity, behavior change, stress management, and peer support.

National Provider Identifier (NPI) = A unique 10-digit number issued by the Centers for Medicare and Medicaid Services (CMS) to health care providers. It is used to identify providers in billing, claims processing, and other health care transactions.

Network adequacy = The extent to which a health plan has a sufficient network of qualified providers and organizations to ensure members have timely, reasonable access to covered services throughout the plan’s service area.

Partner network = A group of organizations that collaborate around a shared mission or goal. Unlike Community Care Hubs (CCHs) and umbrella hub arrangements (UHAs), partner networks typically do not provide centralized contracting, billing, claims processing, or care coordination services.

Pay for performance (P4P) = A value-based payment model in which providers receive financial incentives for meeting established quality, efficiency, or patient outcome targets, rather than being paid solely for the number of services they provide.

Payers = Organizations that pay for health care services, including commercial health insurance plans, employers, managed care plans, Medicaid, and Medicare. Payers establish payment rates, process claims, and reimburse providers for covered services.

Performance Improvement Project (PIP) = A federally required quality improvement project conducted by Medicaid managed care organizations (MCOs) to improve the quality of care or health outcomes for Medicaid members. PIPs may focus on clinical or nonclinical topics, such as diabetes care, reducing hospital readmissions, or addressing substance use disorders.

Principal Illness Navigation (PIN) services = Medicare-covered services that help people with high-risk or serious health conditions navigate the health care system, access needed services, and overcome barriers to care through care coordination and ongoing support.

Produce prescription = A Food is Medicine (FIM) intervention that provides free or discounted fruits and vegetables to people with chronic health conditions, such as diabetes, prediabetes, obesity or heart disease, or to people experiencing food insecurity.

Program supports = Resources provided to participant to help them achieve the goals of the National DPP lifestyle change program and stay engaged. These may include healthy food vouchers, program-related items (such as a scales or food diaries), transportation, child care, gym memberships, or other services that address barriers to participation.

Quality measure = Standardized tools used to assess health care processes, outcomes, patient experience, and other aspects of care delivery. Quality measures help health care organizations evaluate whether care aligns with evidence-based clinical guidelines, benchmark performance, identify gaps in care, and support continuous quality improvement.

Referral-to-enrollment conversion rate = A performance measure that calculates the percentage of individuals who enroll in a program after being referred. It is used to assess the effectiveness of referral processes and community-clinical linkages.

Return on investment (ROI) = Measures the cost of an investment relative to the direct economic benefits it generates. ROI helps determine whether a specific change will result in cost savings or has already done so.

Section 1115 demonstration waiver = Section 1115 of the Social Security Act allows states, with federal approval, to test innovative approaches that support the goals of the Medicaid program. These waivers provide states with additional flexibility to design, demonstrate, and evaluate new approaches within their Medicaid systems, such as expanding eligibility, providing services not typically covered by Medicaid, or using innovative service delivery systems to improve care, increase efficiency, and reduce costs.

Section 1915 home and community-based services (HCBS) waiver = A Medicaid program that allows states to provide long-term services and supports in home and community settings instead of institutions, helping eligible individuals remain in their homes and communities.

Section 1915(b) waiver = Section 1915(b) of the Social Security Act allows states to use the cost savings generated from managed care delivery systems to offer additional health-related services to managed care enrollees. These services require CMS approval and may include programs such as behavioral health services, maternity supports, or other health-related interventions.

Social determinants of health (SDOH) = The conditions in the environments where people live, learn, work, and age that affect health, quality of life, and health outcomes. Differences in these conditions contribute to unequal health outcomes. SDOH are also referred to as social drivers of health.

State plan amendment (SPA) = A request submitted by a state to the Centers for Medicare and Medicaid Services (CMS) to change its approved Medicaid State Plan. A SPA is used to update policies such as covered services, provider eligibility, reimbursement, or other aspects of the Medicaid program.

Third-party organization = An organization that helps health plan, self-insured employers, or Medicaid managed care organization (MCOs) administer programs. Services may include managing networks of CDC-recognized organizations, processing claims, handling billing, and supporting program operations. These organizations may also be called third-party administrators (TPAs), provider integrators, or management service organizations (MSOs).

Type 1 diabetes = A chronic disease in which the body’s immune system attacks the cells in the pancreas that make insulin. People with type 1 diabetes need insulin every day to manage their blood sugar.

Type 2 diabetes = A chronic disease in which the body does not use insulin properly, causing blood sugar levels to rise. It can often be prevented or delayed in people at high risk through healthy lifestyle changes.

Umbrella hub arrangement (UHA) = A model that connects community-based organizations (CBOs) with health care payers to support sustainable reimbursement for programs such as the National DPP lifestyle change program. A UHA includes the umbrella hub organization (UHO), participating organizations (called subsidiaries), and the billing platform used for billing and claims processing. UHAs often work with partners such as health plans, referral networks, and state health departments.

Umbrella hub organization (UHO) = The lead organization in an umbrella hub arrangement (UHA). A UHO coordinates participating organizations and provides administrative services such as contracting, data management, and program oversight.

Umbrella hub subsidiary organization = A community-based organization (CBO) that participates in an umbrella hub arrangement (UHA) and delivers one or more evidence-based programs in their communities.

United States Preventive Services Task Force (USPSTF) = An independent panel of experts that makes evidence-based recommendations about preventive health services, such as screenings, counseling, and preventive medications. Many health plans are required to cover services with a grade A or B USPSTF recommendation without cost-sharing. For some recommendations, counseling requirements may be met by covering the National DPP lifestyle change program

Value-added services = Optional medical or nonmedical services that Medicaid managed care organizations (MCOs) provide beyond covered Medicaid benefits. MCOs may offer these services to improve member health, increase engagement, or make their plans more attractive. Examples include health education, wellness incentives, transportation support, or additional medication benefits.

Value on investment (VOI) = A measure of the overall benefits of investment beyond financial return. VOI considers outcomes such as improved health, quality of life, participant satisfaction, productivity, and other benefits that may not be reflected in a traditional return on investment (ROI).

Content Updated: August 3, 2026