Medicaid Agencies

 
This section provides resources about covering the National Diabetes Prevention Program (National DPP) lifestyle change program in Medicaid.

The Medicaid coverage subsection provides information on the authorities or mechanisms needed to claim state Medicaid funds and federal Medicaid matching funds for the program. The other subsections provide information on how to implement and operate the program in Medicaid, with a focus on a Medicaid fee-for-service environment. Information on how to implement and operate the program in a managed care environment can be found in the Medicaid MCOs section.

In a fee-for-service environment, the Medicaid agency contracts with and pays providers directly for each covered service provided to Medicaid beneficiaries. In a managed care environment, the Medicaid agency contracts with and pays managed care organizations (MCOs) a capitated rate to deliver Medicaid covered services to beneficiaries.

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Download a step-by-step (PDF) summary of how Medicaid agencies can implement the National DPP lifestyle change program.

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Information in this section includes: Overview | Policy to Payment Roadmap | The Role of the State Legislature in Medicaid Coverage | Attaining Coverage Through a Medicaid State Plan | Attaining Coverage Through a Section 1115 Demonstration WaiverAttaining Coverage Through Medicaid Managed Care Coverage OptionsDetermining the Medicaid Enrolled Provider Type | State Stories of 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.

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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.

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Information in this section includes: The Challenge | The Project | The Partners | The Evaluation | Additional Resources & Next Steps |

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.

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Information in this section includes: Overview | Delivery Options | Screening & Identification | Recruitment & Referral | Retention | Network Management

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.

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Approximate costs for administering the National DPP lifestyle change program is $500. This section provides information on various program costs, reimbursement models, and how to consider these costs in rate-setting processes.

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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.

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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.

Content Last Updated: March 5, 2020