Medicare Diabetes Prevention Program (MDPP)

Posted December 5, 2017 by Judith Nelson

The Centers for Medicare & Medicaid Services (CMS) announced that effective April 1, 2018, Medicare members with an indication of pre-diabetes are eligible for clinical interventions that consist of core and maintenance sessions to promote lifestyle changes. In order to provide these services Medicare Advantage health plans can either contract directly with a Medicare enrolled and Centers for Disease Control and Prevention (CDC) recognized supplier or become suppliers of services themselves.

Recently, DST hosted two Strategic Discussion Forums with our customers to discuss the administrative challenges associated with operationalizing this benefit.  During the forum we discussed the following topics:

  • Do you plan to contract with a vendor to provide these services? Several plans are considering contracting with a vendor but are experiencing challenges finding eligible service providers. Also, some vendors expect a per member per month (PMPM) fee while health plans are interested in a fee for service arrangement. Plans were interested in qualified vendors to manage the MDPP program.
  • If you are not contracting with a vendor, what is your contracting and credentialing strategy in order to establish an adequate network? At this time, most plans have not established a strategy to address direct contracting and/or credentialing.
  • What approach will you take to identify members eligible for this benefit? Plans are still assessing the approach to identifying eligible members. 
  • Did you include the MDPP program as a benefit in your 2018 Evidence of Coverage (EOC)?  This benefit was included as part of the model EOC however, about half of the participating plans included this benefit in their evidence of coverage while others did not. Plans that didn't provide information regarding this benefit in the 2018 EOC can notify their members of this benefit using the "Other Mid-Year Changes" instructions in the Medicare Marketing Guidelines. Plans that included the benefit with a January 1, 2018 effective date will also need to provide members with notice of the delayed effective date of April 1, 2018. On November 29, 2017, CMS issued an HPMS memo providing direction on this topic.
  • Other points of interest included: Member incentives, member access to qualified suppliers, the health plan's ability to become a qualified MDPP supplier and Prior Authorization requirements. 

You can find additional information regarding the MDPP program at

The Medicare Advantage program could be experiencing significant change next year and DST Health Solutions will be hosting a monthly Strategic Discussion Forum to include more information sharing related to the MDPP, CMS's proposed policy changes, and other areas of interest.  Please contact Tonya Farling, or Judith Nelson, and we will add you to the meeting invitation. You can also submit topics of interest for future discussion. 

Join in the conversation!  We look forward to engaging in a productive dialogue and sharing information to address opportunities related to the Medicare Advantage Program. 

Judith Nelson headshot
Judith Nelson
Director, Medicare Advantage Strategy

The views expressed in this publication are solely those of the author and do not necessarily reflect the position or policy of DST Systems, Inc. or its affiliates, subsidiaries, joint ventures, officers, directors, or management.

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