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CMS opens Medicare evidence-based diabetes prevention services model to community healthcare organizations

Providers that earn CDC-certification for type 2 diabetes prevention can earn payments for treating patients that might not otherwise be screened.

Susan Morse, Senior Editor

For the first time, the Centers for Medicare and Medicaid Services is encouraging community-based organizations to become service suppliers for the newly-expanded Medicare diabetes prevention program model. 

This gives community hospitals new opportunity in two notable ways: Providers can bill CMS for treating Medicare patients with prediabetes and, because the service is free for qualifying beneficiaries, healthcare organizations can use it to reach those patients who might not have otherwise come in for a screening.  

The model is for community organizations and providers to develop structured behavior change intervention programs to prevent the onset of type 2 diabetes among Medicare beneficiaries who have an indication of prediabetes. 

CMS said that is now allowing community-based organizations to join traditional healthcare providers in enrolling as Medicare suppliers of these health behavior change services. They may provide evidence-based diabetes prevention services after achieving preliminary or full recognition through the Centers for Disease Control and Prevention. 

The model is expected to save the Medicare program more than $180 million by keeping beneficiaries healthy and averting new cases of diabetes.

Medicare spends more than $104 billion every year treating patients with this preventable disease, CMS said. More than a quarter of seniors in this country have type 2 diabetes.

This is the first preventative services test model released by the CMS Innovation Center to expand nationally.

The Medicare diabetes prevention program was launched in 2012 as a small, voluntary model test at 17 sites across the country, in partnership with the YMCA-USA, Centers for Disease Control and Prevention and other public and private partners. 

In the initial model test, 45 percent of beneficiaries met the 5 percent weight loss target, which translates to a clinically meaningful reduction in the risk of developing type 2 diabetes.   

Through the expanded model, trained community health workers and other health professionals are being asked to empower beneficiaries at high risk of developing type 2 diabetes to take ownership of their health through curriculum-driven coaching and proven behavior change strategies for weight control, CMS said.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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