Medicaid

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

Other subsections include state stories of Medicaid coverage for the National DPP lifestyle change program, the role of managed care organizations (MCOs) and value-based care, and implementation and fiscal operations of the program.

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 MCOs a capitated rate to deliver Medicaid covered services to beneficiaries.

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Information in this section includes: Case for Coverage  | 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 WaiverDetermining the Medicaid Enrolled Provider Type | Medicaid Coverage Maps

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 the current landscape of Medicaid coverage for the program.

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Information in this section includes: Medicaid Demonstration | California | Illinois | Maryland  | MichiganMinnesotaMontana | New York | Ohio | Oregon | Pennsylvania

This section provides examples of states that have obtained Medicaid coverage for the National DPP lifestyle change program. The approaches these states took to achieve coverage may help other states think about how they could cover the lifestyle change program in their state Medicaid program.

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Information in this section includes: Engaging MCOs to Attain Coverage | Engaging ACOs

This section provides information on the role MCOs can play in promoting Medicaid coverage for the National DPP lifestyle change program, and how to engage accountable care organizations (ACOs) in efforts to prevent type 2 diabetes.

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Information in this section includes: Communicating and Promoting the National DPP as a Medicaid Benefit | Delivery OptionsScreening & IdentificationRecruitment & ReferralRetention

This section provides information on steps Medicaid agencies and their partners, especially state health departments, 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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Information in this section includes: MCO Contracting | ReimbursementCoding and BillingData, Reporting, and Evaluation

This section provides information on fiscal operations of the National DPP lifestyle change program including contracting between partners, reimbursement models, steps for coding and billing, and information on data collection for reporting and evaluation of the program.

Content Updated: February 2, 2024