Medicaid MCOs

 

This section provides resources about covering the National Diabetes Prevention Program (National DPP) lifestyle change program by Medicaid managed care organizations (MCOs).
 
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. In a fee-for-service environment, the Medicaid agency contracts with and pays providers directly for each covered service provided to Medicaid beneficiaries. Information on how to implement and operate the program in a fee-for-service environment can be found in the Medicaid Agencies section.
 
Click here for a map to see if your state uses Medicaid managed care.

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Download a step-by-step (PDF) summary of how Medicaid MCOs can implement 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 | Enrollment, Incentives, & Retention | Network Management 

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.

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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.

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Information in this section includes: State MCO Contracts and Contract Amendments | Contracting with CDC-Recognized Organizations
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.

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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