CMS Covers DPP in Fee-For-Service Medicare

Written by: Adam Kaufman, PhD, CEO Canary Health

This month marked an exciting milestone in the progress to provide support for individuals with pre-diabetes. CMS further clarified and committed itself to covering the Diabetes Prevention Program in fee-for-service Medicare.  We know that millions of people in the US and millions more are progressing towards diabetes and we know effective ways to help many of them prevent or slow this progression.  Importantly, the core of effective diabetes prevention is support for self-management and behavior change.  We’re thrilled that CMS has continued to show commitment to these principles and to an innovative way to invite non-traditional providers through the Medicare-DPP program.  You can read their current near-final draft rule here…

This is important not only for the millions who will get access to DPP services directly through Medicare coverage, but also because many private payers look to Medicare decisions for guidance.  We’re optimistic that this points to not only broader DPP coverage but expanded coverage for self-management support and behavior change programs.

I would be remiss to not express my disappointment that the current plans from CMS do not include covering Digital-DPP providers.  We, along with other rigorous digital DPP providers have demonstrated strong engagement and outcomes and believe all-options should be allowed for consumers.  And importantly we’ll not be able to serve all those that could benefit without virtual providers.  We’re optimistic that as CMS learns more and we can further demonstrate program results digital will be added to the MDPP.