Medicare Diabetes Prevention Program (MDPP) Suppliers

10.2.6 - Medicare Diabetes Prevention Program (MDPP) Suppliers (Rev. 12717; Issued: 07-18- 24; Effective: 08-19-24; Implementation: 08-19-24) A. General Background Information MDPP is a structured lifestyle intervention that includes dietary coaching, lifestyle intervention, and moderate physical activity, all with the goal of preventing the onset of diabetes in individuals who are pre-diabetic. An entity or individual seeking to furnish MDPP services to Medicare beneficiaries must enroll as an “MDPP supplier” via the Form CMS-20134. Such suppliers must meet the following enrollment requirements: • Has: (1) MDPP preliminary recognition; (2) full recognition as determined by the Center for Disease Control and Prevention’s (CDC) Diabetes Prevention Recognition Program (DPRP); or (3) full CDC recognition plus DPRP recognition. • Maintains a valid TIN and NPI at the organizational level • Passed screening requirements at a high categorical risk level per § 424.518(c) upon initial enrollment and revalidate at the moderate categorical risk level per § 424.518(b) and • Complies with the supplier standards MDPP supplier applicants do not require any licensure, accreditation, or certificates to be eligible to enroll as an MDPP supplier. Rather, the CDC administers the curriculum for the MDPP and monitors the organization’s fidelity to and success with furnishing the services. Thus, organizations with preliminary or full recognition from the CDC’s DPRP indicate that they are prepared to deliver MDPP services. As a part of the expanded CMMI model, CMS will only accept in-person MDPP suppliers to enroll in Medicare. MDPP suppliers can provide any combination of in-person and distance learning sessions and they would still be considered in-person MDPP suppliers. In June 2024, CDC released the 2024 Diabetes Prevention Recognition Program (DPRP) Standards (https://nationaldppcsc.cdc.gov/s/article/DPRP-Standards-and-Operating-Procedures) that included five types of CDC DPRP organization recognition codes: “in-person”, “in-person with a distance learning component”, “distance learning”, “online”, and “combination with an online component”. The contractor can approve MDPP applications for organizations that demonstrate an “in-person” or an “in-person with a distance learning component” CDC DPRP recognition code. B. MDPP Supplier Standards All MDPP suppliers must comply with MDPP supplier standards to obtain and retain Medicare billing privileges. Consistent with 42 CFR § 424.205(c), each MDPP supplier must certify on its Form CMS-20134 enrollment application that it meets and will continue to meet the following standards (listed in § 424.205(c)) and all other requirements: (1) Must have and maintain: (1) MDPP preliminary recognition; (2) full CDC recognition; or (3) full CDC recognition plus DPRP recognition. (2) Must not currently have its billing privileges terminated or be excluded by a state Medicaid agency (3) Must not permit MDPP services to be furnished by or include on its roster any individual coach who meets the ineligibility criteria in § 424.205(d)(1) (4) Must maintain at least one administrative location on an appropriate site. All administrative locations, must be reported on their CMS-20134 form and may be subject to site visits. (See § 424.205(c)(4) for more information regarding site requirements.) (5) Must update the enrollment application within 30 days for any change of ownership, change to the coach roster, change of practice location (including additions and deletions of locations), and final adverse legal action history, and update all other changes within 90 days (6) Must maintain a primary business telephone that is operating at administrative locations or directly where services are furnished. The associated telephone number must be listed with the name of the business in public view. (7) Must not convey or reassign a supplier billing number (8) Must not deny an MDPP beneficiary access to MDPP services during the MDPP benefit period, including conditioning access to MDPP services on the basis of an MDPP beneficiary’s weight, health status, or achievement of performance goals (with certain exceptions described in § 424.205(c)(8)(i)) (9) Must not---nor may other individuals or entities performing functions or services related to MDPP services on the MDPP supplier's behalf---directly or indirectly commit any act or omission, or adopt any policy that coerces or otherwise influences an MDPP beneficiary’s decision to begin accessing MDPP services or change to a different MDPP supplier specifically (10) Must offer an MDPP beneficiary no fewer than the services described in § 424.205(c)(10) (11) Must disclose detailed information about the MDPP benefit to each beneficiary to whom it furnishes MDPP services before the initial core session is furnished, including the set of services, eligibility requirements, the once-per-lifetime nature of MDPP services, and the standards in § 424.205(c) (12) Must answer MDPP beneficiaries’ questions about MDPP services and respond to MDPP related complaints. An MDPP supplier must implement a complaint resolution protocol and maintain documentation of all beneficiary contact regarding such complaints, including the name and Medicare Beneficiary Identifier of the beneficiary, a summary of the complaint, related correspondences, notes of actions taken, and the names and/or NPIs of individuals who took such action on behalf of the MDPP supplier. This information must be kept at each administrative location and made available to CMS or its contractors upon request (13) Must maintain a crosswalk file which indicates how participant identifications for the purposes of CDC performance data correspond to corresponding beneficiary health insurance claims numbers or Medicare Beneficiary Identifiers for each MDPP beneficiary. The MDPP supplier must submit the crosswalk file to CMS or its contractor (14) Must submit performance data for MDPP beneficiaries who attend ongoing maintenance sessions with data elements consistent with the CDC’s DPRP standards for data elements required for the core benefit (15) Must allow CMS or its agents to conduct onsite inspections or recordkeeping reviews in order to ascertain the MDPP supplier’s compliance with these standards, as well as the documentation requirements outlined § 424.205(f) The CMS will notify the contractor when an MDPP supplier within its jurisdiction has moved from preliminary or full recognition down to pending and therefore no longer maintains eligibility as an MDPP supplier. For those suppliers that no longer have a valid recognition level to maintain their MDPP supplier enrollment, the contractor shall take the necessary steps to revoke the supplier’s billing privileges. Violations of the supplier standards are determined as non-compliance and the associated enrolment denial and revocation authorities would apply.