Nina Brown-Ashford Outlines Development and Next Steps of CMS Diabetes Prevention Program

The Diabetes Prevention Program (DPP) has demonstrated that it can improve the quality of care for Medicare beneficiaries with diabetes while saving or maintaining costs, explained Nina Brown-Ashford, MPH, CHES, deputy group director at the CMS Innovation Center. Next, CMS will finalize the DPP’s expansion in another round of rulemaking.

Transcript (slightly modified)

What impact has the Affordable Care Act had on the Diabetes Prevention Program?

The Medicare Diabetes Prevention Program model is being expanded in duration and scopre through Section 1115 AC of the Social Security Act, which basically gives CMS the authority to test models, so that was the original YUSA healthcare innovation award that tested delivery of DPP to individuals 65 years or over.

Once the evaluation results demonstrate that it’s improved quality while either maintaining cost neutrality, so not increasing costs, or didn’t decrease quality while saving money, and doesn’t deny or limit access to benefits or coverage for Medicare beneficiaries, then the Office of the Actuary can certify the program for expansion in duration and scope, and the Secretary can make a determination to expand the program nationally, which is what happened with the DPP program.

What are the ongoing efforts and next steps in rolling out and expanding the DPP?

The DPP as outlined in Section 1115 AC is being expanded through rulemaking, so the next steps are we will go through one final round of rulemaking to finalize additional aspects of the program that were not addressed in the 2017 Physician Fee Schedule, so everyone should be on the lookout for that next round of rulemaking. When the proposed rule comes out, please comment, provide your feedback as we finalize the program for a go-live date on or after January 1 of 2018.