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Entries in Medicare Diabetes Prevention Program (1)

Thursday
Sep152016

IHRSA Submits Comments on Medicare Diabetes Prevention Program

On September 6, IHRSA formally submitted comments to the Center for Medicaid & Medicare Services (CMS) concerning the proposal that Medicare cover the cost of a preventative service incorporating physical activity and diet interventionthe Medicare Diabetes Prevention Program (MDPP).

The MDPP stands to be the first ever preventative service model certified for expansion by the CMS Innovation Center.

Opportunities for Health Clubs in MDPP

With the proposal that Medicare will cover the cost of MDPP, health clubs are in an advantageous position to administer the program and become a vital component in the healthcare system.

The program consists of educational sessions on healthy habits for individuals at risk of diabetes, evidenced by blood test results (and covered by Medicare), beginning with an initial six-month period with a core curriculum. The curriculum incorporates the importance of physical activity in healthy living, in addition to nutrition and stress management. The primary goal of the program is weight loss and behavior change to prevent against diabetes—both goals achievable in a health club setting. 

To maximize the contribution that the health and fitness industry can make to the success of this major innovation in Medicare, IHRSA focused its comments on ways to position health clubs as settings for the MDPP and to facilitate club participation. 

Per participant, a health club offering MDPP would be reimbursed by Medicare, with some payments dependent on the participant’s percentage of achieved weight loss and attendance level. The provider would be reimbursed up to $450 per person in the first year, and up to $180 in the participant’s second year of the program.

Expanding the Program Nationally

IHRSA encouraged CMS to launch this important effort on a national basis, given that diabetes impacts Americans across the nation.

According to the CDC, 25% of Americans age 65 or older have Type 2 diabetes, and almost half have prediabetes. The CMS is considering an alternate approach of phasing in the program (such as by geographic location or by subpopulation).

Considering Coverage of Other Chronic Diseases

IHRSA stated in its comments to CMS that MDPP and its emphasis on healthier lifestyles and physical activity would also result in cost savings to Medicare if offered to persons at risk of developing other chronic diseases, such as hypertension or cardiovascular problems.

It is important to focus attention on the proven success of preventative service models and the urgency of combatting chronic disease. About one in two adults live with a chronic disease, straining the American workforce and economy, but many diseases can be prevented with participation in physical activity and other healthy habits.

What’s Next?

Now that the comment period has ended for the MDPP rule, it is expected that a formal rule will be published in November 2016 and that potential program providers can apply for CDC recognition in 2017. Then, in 2018, providers can begin to be reimbursed for the service.

When further news is available, IHRSA will continue to share information with clubs. If you have questions or comments, please email IHRSA’s public policy department at gr@ihrsa.org.