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Summary

CMS fact sheet dated 05/10/2023, Participants in the Medicare Diabetes Prevention Program: CMS Flexibilities to Fight COVID-19, on temporary changes to the Medicare Diabetes Prevention Program (MDPP) expanded model during the COVID-19 public health emergency (PHE). It says CMS waived the 5% weight loss requirement for participants enrolled on or before 12/31/2020, waived the once-per-lifetime limit for certain beneficiaries whose in-person sessions were suspended, and lifted the limit on virtual make-up sessions. When the PHE ends, the flexibilities will generally cease and suppliers must return to a primarily in-person format, though beneficiaries who began or switched to virtual services during the PHE may continue virtually.

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       Participants in the Medicare Diabetes Prevention Program:
                   CMS Flexibilities to Fight COVID-19
At the beginning of the COVID-19 Public Health Emergency (PHE), CMS used emergency waiver
authorities and various regulatory authorities to enable flexibilities so providers could rapidly
respond to people impacted by COVID-19. CMS developed a cross-cutting initiative to use a
comprehensive, streamlined approach to reestablish certain health and safety standards and
other financial and program requirements at the eventual end of the COVID-19 public health
emergency.

This CMS cross-cutting initiative focused on evaluating CMS-issued PHE waivers and flexibilities
to prepare the health care system for operation after the PHE. This review happened in three
concurrent phases:

1. CMS assessed the need for continuing certain waivers based on the current phase of the
   PHE. Since the beginning of the PHE, CMS has both added and terminated flexibilities and
   waivers as needed. In doing so, CMS considered the impacts on communities — including
   underserved communities — and the potential barriers and opportunities that the
   flexibilities may address.

2. CMS assessed which flexibilities would be most useful in a future PHE, such as natural and
   man-made disasters and other emergencies, to ensure a rapid response to future
   emergencies, both locally and nationally, or to address the unique needs of communities
   that may experience barriers to accessing health care.

3. CMS is continuing to collaborate with federal partners and the health care industry to
   ensure that the health care system is holistically prepared for addressing future
   emergencies.

As CMS identified barriers and opportunities for improvement, the needs of each person and
community served were considered and assessed with a health equity lens to ensure our
analysis, stakeholder engagement, and policy decisions account for health equity impacts on
members of underserved communities and health care professionals disproportionately serving
these communities.

Please note: This fact sheet focuses on Medicare and Medicaid flexibilities only.
The Medicare Diabetes Prevention Program (MDPP) expanded model aims to prevent
progression to Type 2 diabetes in eligible individuals with an indication of prediabetes. The
majority of services furnished under the MDPP expanded model are currently required to be
furnished in person, except for limited virtual make-up sessions. Read more about MDPP at:
https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/.


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In addition, the program includes clear interval timeframes in which beneficiaries must attend a
prescribed number of classes and meet weight loss goals in order to remain eligible for MDPP
services. For example, a beneficiary who enrolled in MDPP in 2021 or earlier must meet the 5%
weight loss goal in order to satisfy the eligibility criteria to move on to the second year of
services. Starting in 2022, MDPP became a one-year program to better align with the CDC’s
National Diabetes Prevention Program (National DPP).

CMS understands that the health and safety of MDPP staff and beneficiaries are paramount and
realizes that concerns about COVID-19 may have resulted in the suspension of MDPP in-person
class sessions during this national emergency. The CDC released guidance to CDC-recognized
organizations on its National DPP, providing alternative delivery options during the COVID-19
national emergency, including encouraging organizations to use virtual make-up sessions as
necessary, regardless of usual delivery mode. If virtual make-up sessions were not possible,
organizations could pause offering classes. When classes resumed, CDC allowed DPP providers
to pick up where they left off or to restart the program from week one. Our goal was to align
MDPP expanded model-specific changes as much as possible to what the CDC released for the
duration of the PHE. We have established flexibilities during the PHE through two rounds of
rulemaking.

For suppliers and beneficiaries participating in the expanded model as of the beginning of the
public health emergency, CMS has made the following temporary changes to MDPP:

   •   Extended the flexibilities, finalized in the March 31st COVID-19 IFC, to all beneficiaries
       who were receiving MDPP services as of March 31, 2020, instead of March 1, 2020.

   •   Five percent weight loss waiver: For participants enrolled in MDPP on or before
       12/31/2020, we waived the 5% weight loss requirement for beneficiary eligibility to
       continue in the Ongoing Maintenance Session interval. CMS reinstated the 5% weight
       loss requirement to continue ongoing maintenance for participants who started MDPP
       on or after 1/1/2021.

   •   Waived the once-per-lifetime limit for certain beneficiaries: Beneficiaries who were
       receiving MDPP services as of December 31, 2020, and who's in-person sessions were
       suspended due to the PHE, may elect to restart the set of MDPP services at the
       beginning or resume with the most recent attendance session of record. Once the
       COVID-19 PHE ends, beneficiaries who have not received MDPP services virtually; or for
       whom no MDPP claims with dates of service (DOS) occurring during the PHE, may
       restart the MDPP set of services at the first core session or elect to pick up the MDPP
       set of services where they left off. Participants who begin the set of MDPP services on
       or after January 1, 2021, who are in the first 12 months of the set of MDPP services as of
       the start of an applicable 1135 waiver event, who's in-person sessions are suspended
       due to the applicable 1135 waiver event, and who elect not to continue with MDPP



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       services virtually, may elect to restart the set of MDPP services at the beginning or may
       resume with the most recent attendance session of record.

   •   Waived limit to number of virtual services: The limit placed on the number of virtual
       make-up sessions described at 42 CFR § 410.79 will not apply during the remainder of
       the COVID-19 PHE or during any future applicable 1135 waiver event for MDPP
       suppliers to provide MDPP services virtually, as long as the virtual services are furnished
       in a manner that is consistent with the CDC DPRP standards for virtual sessions, follow
       the CDC-approved DPP curriculum requirements, and the supplier has an in-person
       DPRP organizational code. Virtual sessions may be used to achieve both attendance and
       weight loss goals.

   •   Waived the requirement for in-person attendance at the first core session during an
       1135 waiver event: Allowing MDPP suppliers to obtain weight measurements in a
       number of ways ranging from in-person to virtual using BluetoothTM technology. This
       allows suppliers to bill for participants achieving weight loss performance goals.

When the COVID-19 PHE ends, the above flexibilities will generally cease to be available and
suppliers will be required to follow the MDPP supplier standards when delivering MDPP, which
includes a primarily in-person format and limits on virtual make-up sessions.

Beneficiaries who began the set of MDPP services virtually or who changed from in-person
MDPP services to virtual during the PHE may continue the MDPP set of services virtually even
after the PHE has concluded. Beneficiaries who were receiving MDPP services as of December
31, 2020, and who's in-person sessions were suspended due to the PHE may elect to restart the
MDPP set of services at the beginning or pick up the MDPP set of services where they left off.
This applies to beneficiaries who were enrolled in MDPP on or before May 11, 2023.


Additional Guidance
   • MDPP Emergency Policy can be found in the Calendar Year 2021 Physician Fee Schedule
       at https://www.govinfo.gov/content/pkg/FR-2020-12-28/pdf/2020-26815.pdf.

   •   MDPP updates can be found in the Calendar Year 2022 Physician Fee Schedule at
       https://www.govinfo.gov/content/pkg/FR-2021-11-19/pdf/2021-23972.pdf.

   •   Correction Notice for the Calendar Year 2022 MDPP Payment Rates can be found at
       https://www.govinfo.gov/content/pkg/FR-2021-12-27/pdf/2021-27853.pdf.




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