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Dec 18, 2020

CMS Issues Final Policies for Medicare Diabetes Prevention Program (MDPP) CY 2021


The Centers for Medicare & Medicaid Services (CMS) recently released the final policies for the 2021 calendar year (CY) Physician Fee Schedule (PFS). CMS outlines the revisions for specific MDPP policies during the remainder of the COVID-19 Public Health Emergency (PHE) and for any future applicable 1135 waiver event.

Please see details here: 2021 PFS Final Rule

Summary of the CY 2021 Final Rule

As 1135 waiver events could disrupt in-person MDPP services because of possible health and safety reasons, CMS is finalizing a revision to the 3/31/2020 COVID-19 Interim Final Rule with Comment Period (IFC) to provide certain flexibilities as appropriate. This will be effective January 1, 2021 until the remainder of the COVID-19 PHE and all future applicable 1135 waiver events.

MDPP Once Per Lifetime Set of Services

  • Temporarily permit certain beneficiaries to obtain the set of MDPP services more than once per lifetime
  • Waive the 5% weight loss eligibility requirements to participate in ongoing maintenance year
  • Allow certain MDPP suppliers to either pause the delivery of MDPP services or deliver MDPP sessions virtually temporarily
  • Virtual Weight Measurement methods and self-reporting and use of online video technologies for MDPP coaching
  • MDPP suppliers have flexibility to deliver services virtually or suspend in person services and resume services at a later date
  • Allow MDPP beneficiaries who begin services virtually, or who change from in person services to virtual during the PHE or applicable 1135 waiver event, to continue the services virtually even after the conclusion of the PHE or 1135 waiver event
  • Extend the flexibilities 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

Virtual Make-up and Regular Sessions

  • The limit placed on the number of virtual make-up sessions will not apply during the remainder of the PHE or any future 1135 waiver event for MDPP suppliers to provide services virtually
    • As long as virtual services are consistent with CDC Diabetes Prevention Recognition Program (DPRP) standards for virtual sessions, follow CDC approved DPP curriculum requirements and supplier has an in-person DPRP organizational code
  • Amended regulations to clarify that all sessions may be offered virtually as a virtual class consistent with in-person class curriculum during the remainder of the COVID-19 PHE and applicable future 1135 waiver events
  • MDPP beneficiaries will be allowed to continue MDPP services virtually even after the conclusion of the PHE or applicable 1135 waiver event
  • Under the temporary flexibilities, the requirement for in-person attendance at the 1st core session does not apply
  • During the remainder of the COVID-19 PHE and any future applicable 1135 waiver event, MDPP Suppliers may obtain weight measurements via the following methods:
    • In person
    • Digital Technologies
    • Self-report from MDPP own at-home digital scale.
      • Must be submitted via video or photo by MDPP beneficiary to the MDPP Supplier that clearly documents the weight as it appears on the scale on the date associated with the billable MDPP session
    • Use of synchronous, online video technology such as video chatting of video conference with MDPP coach where coach can clearly observe the self-reported weight of the MDPP beneficiary

Weight Loss Requirements and Eligibility for Ongoing Maintenance Sessions

  • The 5% weight loss eligibility waiver will end for MDPP beneficiaries starting after January 1, 2021. MDPP beneficiaries who start the set of MDPP services on or after January 1, 2021 will be required to meet and maintain the 5% weight loss goal to be eligible for the ongoing maintenance year
  • However, the 5% weight loss to maintain eligibility will remain in effect for MDPP beneficiaries who were receiving MDPP services prior to January 1, 2021

Beneficiary Engagement Incentives

  • The definition of “engagement incentive period” has not changed.
    • The engagement incentive period will end if the MDPP supplier has not had direct contact with the MDPP beneficiary, whether in person, by telephone, or via other telecommunication technology for more than 90 consecutive calendar days during the MDPP service period
    • It will not end with respect to an MDPP beneficiary who begins to receive MDPP services virtually within 90 days after the occurrence of an 1135 waiver event that CMS determines is likely to disrupt the furnishing of in-person MDPP services