MDPP Expanded Model
Medicare Diabetes Prevention Program (MDPP) Expanded Model
The Medicare Diabetes Prevention Program (MDPP) Expanded Model is an evidence-based behavior change intervention to delay or prevent the onset of type 2 diabetes among people with Medicare. This voluntary model was certified for expansion in 2016 and is covered under Medicare Part B as a preventive service.
Innovation
MDPP is a one-year health behavior change educational program covered under Medicare Part B as a preventive service, utilizing CDC-recognized community-based organizations and coaches to deliver services in-person, via distance learning, or online.
The Problem
Nearly 1 in 2 adults aged 65 and older have prediabetes; without intervention, the prevalence and costs of treating type 2 diabetes among people with Medicare will continue to rise.
The Solution
MDPP, a one-year health behavior change educational program, has demonstrated effectiveness in delaying or preventing the onset of type 2 diabetes among people with prediabetes.
Expected Outcomes
By widely implementing this program among people with Medicare, the MDPP Expanded Model can improve health and decrease costs associated with complications of diabetes, like hypercholesterolemia or hypertension.
Strategy
Participating in the MDPP is a preventive approach to managing the risk for type 2 diabetes that empowers beneficiaries to make healthy lifestyle changes and manage their own health.
Model Goals
- Delay or prevent the onset of type 2 diabetes among people with Medicare
- Improve health and decrease costs associated with complications of diabetes
Patient Eligibility
Medicare beneficiaries with an indication of prediabetes who do not have a history of type 1 or 2 diabetes and do not have End-Stage Renal Disease (ESRD).
- Must have Medicare Part B coverage
- Must have an indication of prediabetes (via fasting plasma glucose, oral glucose tolerance test, or HbA1c test)
- No history of type 1 or 2 diabetes (other than gestational)
- Must not have End-Stage Renal Disease (ESRD)
Provider Eligibility
Organizations must obtain CDC preliminary or full Diabetes Prevention Recognition Program (DPRP) recognition and enroll in Medicare as an MDPP supplier.
- Obtain CDC preliminary or full DPRP recognition
- Enroll in Medicare as an MDPP supplier via PECOS
- Maintain a roster of all coaches furnishing MDPP services
- Pass high-risk screening including fingerprint-based background checks for individuals with 5% or greater ownership interest
Care Categories
Preventive Care
CMS Benchmarks & Thresholds
eligibility
financial
operational
population
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