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National Indian Health Board – CMS Seeks Comments on Expanding Medicare Reimbursement for the Diabetes Prevention Program

August 2, 2016

CMS Seeks Comments on Expanding Medicare Reimbursement for the Diabetes Prevention Program


The Centers for Medicare and Medicaid (CMS) is seeking comments on a proposed rule that will update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. As part of this rule, CMS is proposing to expand the Diabetes Prevention Program model starting January 1, 2018.  This is the second CMS Innovation Center – and first preventive services – model that has been certified for expansion.  Expansion of this model will enhance access to these important services for Medicare beneficiaries who are at risk for developing type 2 diabetes.


It is important to note that under this proposed rule, Special Diabetes Program for Indians (SDPI) grantees, that are or have implemented a lifestyle change diabetes prevention (DP) program known as the SDPI DP initiative, will be required to have their lifestyle change program be preliminary recognized by the Centers for Disease Control (CDC) Diabetes Prevention recognition program (DPRP) in order to be reimbursable through Medicare.


Please click here to view the section of the CMS proposed rule that refers to the expansion of the Diabetes Prevention Program.  For the full rule:  https://www.gpo.gov/fdsys/pkg/FR-2016-07-15/pdf/2016-16097.pdfsee pages 46413-46418.


The Center for Medicare & Medicaid Innovation (CMS Innovation Center) will host a webinar to discuss various aspects of the Medicare Diabetes Prevention Program proposal on Tuesday, August 9, 2016 from 12:00-1:00pm EDT. Registration for this webinar is now open.


To learn more about these efforts to support and improve access to primary care please review the CMS Fact Sheet.


Comments are due on September 6, 2016 and can be submitted  here.


NIHB will be hosting a Tribal-only call in mid-August to provide more information and solicit Tribal feedback on the proposed rule.  Please contact Devin Delrow, Director of Federal Relations, ddelrow@nihb.org or Karrie Joseph, kjoseph@nihb.org, Public Health Program Manager, for more information.


Last modified: September 20, 2020