Medicare Diabetes Prevention Program (MDPP) Expanded Model Crosswalk Guidance Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI)
Dis isclaimer This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently, so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. 2
Agenda The agenda for today’s presentation is outlined below. Background on MDPP 4 Overview of the MDPP Crosswalk 9 Submission Logistics and Dates 12 Beneficiaries Considerations 18 Requirements for Recordkeeping 23 Appendix 44 Note: Full crosswalk guidance can be found at: https://innovation.cms.gov/Files/x/mdpp-crosswalk-guidance.pdf 3
Overview Submission Beneficiaries Requirements MDPP Background 4
The Problem The Solution Benefits of MDPP Next Steps The Medicare Dia iabetes Prevention Program (M (MDPP) A group-based intervention targeting at-risk Medicare beneficiaries, using a CDC-approved National Diabetes Prevention Program curriculum. Up to 2 years of sessions delivered to groups of eligible beneficiaries As a Medicare preventive service , there are no out-of- pocket costs. Coaches furnish MDPP services on behalf of MDPP suppliers MDPP suppliers’ primary goal is to help Medicare beneficiaries achieve at least 5% weight loss 5
The Problem The Solution Benefits of MDPP Next Steps MDPP Benefic icia iary ry Elig ligib ibil ilit ity Requir irements MDPP is available to Medicare beneficiaries with an indication of prediabetes. Blood Tests and Body Mass Index (BMI) Medicare Eligibility Beneficiaries must present one of three blood tests indicating prediabetes and Beneficiaries must have coverage BMI of at least 25 (or 23 if self- through Original Medicare (Part B) or identified as Asian). Medicare Advantage (Part C) Other Medical History Beneficiaries must not have a previous diagnosis of diabetes or End Stage Renal Disease, and no previous receipt of MDPP services 6
The Problem The Solution Benefits of MDPP Next Steps Medicare Diabetes Prevention Program (MDPP) Journey MDPP suppliers who are ready to submit crosswalk data have reached step 5 of the MDPP Journey. Provide MDPP services and Achieve CDC preliminary or full recognition Apply for CDC recognition submit claims Organizations must obtain CDC preliminary or full DPRP Apply to the Centers for Disease Control and MDPP suppliers can billMedicare recognition before enrolling as an MDPPsupplier. Prevention (CDC) Diabetes Prevention for delivering MDPP services. Recognition Program (DPRP). • CDC preliminary or full DPRP recognition helps assure that organizations have the capacity to become MDPP 1. Submit an application online to become MDPP Services: suppliers. a CDC-recognized organization. • Include up to 2 years of sessions dependent on beneficiary weight loss 2. Offer the program for 12 months. • Visit the CDC’s Customer Support Center at https:// and attendance. nationaldppcsc.cdc.gov/s/ for information on CDC 3. Submit evaluation data to CDC every 6 recognition. • Follow a performance-based payment months. structure of up to $689 per eligible beneficiary. MDPP Claims: • Are only received when submitted through Medicare Administrative Contractors (MACs). Prepare to enroll as an MDPP supplier Apply to become an MDPP supplier Choose one of the options to enroll as an MDPP Learn about MDPP enrollment requirements as supplier after gaining CDC recognition: you work towards CDC recognition. • Visit the MDPP website and review enrollment materials suchas • Enroll online using the https://pecos.cms.hhs.gov/pecos/login.do.** the Enrollment Fact Sheet 1 and the EnrollmentChecklist 2 . • Submit a paper CMS-20134 form. • Organizations should obtain a separate NPI to be used for MDPP enrollment in order to reduce claim rejections and denials that **Recommended 7 may occur if multiple enrollments are associated with a single 1 https://innovation.cms.gov/Files/x/mdpp-enrollmentfs.pdf; 2 https://innovation.cms.gov/Files/x/mdpp-enrollmentcl.pdf NPI.
In Inter-Agency Coordination CMS and CDC each have unique roles and responsibilities with respect to MDPP services. Payment, Enrollment, and Oversight Arm Quality Assurance Arm MDPP suppliers receive payment from CMS MDPP suppliers must maintain CDC and must meet and remain compliant with recognition and follow CDC quality standards, requirements established by Medicare including use of a CDC-approved curriculum 8
Overview Submission Beneficiaries Requirements Crosswalk Overview 9
Overview Submission Beneficiaries Requirements Crosswalk Fundamentals Closely tracking, recording, and monitoring beneficiary data is essential to the success of an MDPP supplier. Cadence Overview Supplier Requirement All MDPP suppliers must The crosswalk matches beneficiary Maintenance and submission of begin submitting crosswalks identifiers used for your CDC a crosswalk is an MDPP supplier to CMS’s evaluation partner performance data submissions with standard that supplier’s must after they have furnished the corresponding Medicare meet to retain enrollment in MDPP services for six identifiers for each beneficiary who Medicare as an MDPP supplier. months, then quarterly receives MDPP services. This thereafter. information will help facilitate the evaluation of MDPP. 10
Overview Submission Beneficiaries Requirements Crosswalk Logistics Crosswalks must be maintained by MDPP suppliers as a spreadsheet (e.g. Excel). The crosswalk exists as one file, divided into two tabs: “FFS Medicare” and “Medicare Advantage” 11
Overview Submission Beneficiaries Requirements Crosswalk Submission 12
Overview Submission Beneficiaries Requirements Crosswalk Submission The chart below outlines if a supplier must submit a crosswalk at the upcoming quarterly due date. Is s your or organization an an MDP DPP supplier? sup Only MDPP suppliers need to submit an Your organization is an MDPP MDPP crosswalk file. Your organization does supplier if you received final No not need to submit an MDPP Crosswalk File approval from CMS confirming your to CMS. enrollment in Medicare as an MDPP supplier after submitting an MDPP supplier enrollment application to You do not yet need to submit a crosswalk Medicare. file. MDPP suppliers must submit an MDPP crosswalk Yes file six months after they begin to provide MDPP services, starting at the next quarterly due date . Has your organization started to furnish MDPP No services? You must submit a crosswalk file at the upcoming Yes due date, and at each quarterly due date thereafter. Please visit the MDPP Crosswalk Registration Form In the Crosswalk Submission (http://bit.do/MDPP-Register) and the MDPP Table , find the next upcoming Crosswalk File Submission FAQs quarterly crosswalk submission ( https://innovation.cms.gov/initiatives/medicare- Yes date. Was your first session of diabetes-prevention-program/faq.html#crosswalk) . MDPP services furnished before If you have not received guidance on how to access or during the time period the Crosswalk File Template and upload your 13 indicated in the left hand column? Crosswalk File to CMS email MDPP@cms.hhs.gov.
Overview Submission Beneficiaries Requirements Crosswalk Submission Due Dates To determine when your organization must submit its first crosswalk to CMS, you must identify the date that your organization furnished its first session of MDPP services. Suppliers must submit their crosswalk… then… Six months after they begin furnishing MDPP On a quarterly basis all suppliers must submit services, starting at the next quarterly due date (as indicated by the due dates below) Crosswalk Submission Table In the Crosswalk Submission Table, find the next upcoming quarterly crosswalk submission date Date of MDPP supplier’s first crosswalk submission Date of first MDPP service provided by MDPP supplier Between January 1 and March 31 October 15 Between April 1 and June 30 January 15 Between July 1 and September 30 April 15 Between October 1 and December 31 July 15 14
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