Dietitian Course: Reimbursement and CDC Recognition for the Medicare Diabetes Prevention Program: Pre-COVID Rules and CMS Current PHE Waivers

REIMBURSEMENT AND CDC RECOGNITION FOR THE MEDICARE DIABETES PREVENTION PROGRAM: PRE-COVID RULES AND CMS CURRENT PHE WAIVERS

Diabetes affects more than 25% of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. CMS estimates that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes. Per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes. Fortunately, type 2 diabetes can usually be delayed or prevented with health behavior changes that focus on diet and physical activity. The Medicare Diabetes Prevention Program (MDPP) expanded model is a structured behavior change intervention that aims to prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. This model is an expansion of the Diabetes Prevention Program (DPP) model test, which was tested through the Center for Medicare and Medicaid Innovation's Health Care Innovation Awards. In this webinar, Mary Ann will review the Medicare reimbursement rules for the MDPP, and also the CDC requirements for pending, prelimary and full recognition for any diabetes prevention program, not just one to bill Medicare. RDNs are the perfect healthcare professionals to furnish the MDPP, based on the CDC curriculum for it. All billing rules are reviewed, as well as how suppliers enroll in Medicare to furnish and bill for the MDPP. CMS has allowed many waivers and flexibilities in the rules for the pandemic, many of which will continue even after the PHE.

Upon successful completion of this course, the participant should be able to:

State the 3 levels of CDC recognition for a Diabetes Prevention Program (DPP) and for the MDPP.

State the phases of the MDPP, both pre-covid and currently with the CMS waiver; explain what has changed.

Explain the current MDPP reimbursement rules with regard to all virtual visits.

Explain the >5% weight loss goal and how beneficiaries can now be weighed that is not in-person.

State what the beneficiary attendance requirements are for coverage in the 2 phases of the MDPP.

Explain CDC's requirements for Lifestyle Change Coaches in the DPP and MDPP.

State the eligibility requirements for Medicare beneficiaries to start the MDPP, and how they differ from the CDC participant eligibility requirements.

Explain the CMS requirements to become a MDPP "supplier" and thus be able to bill Medicare.

Review how Medicare reimburses suppliers for the MDPP.

State the new maximum reimbursement amount now that CMS has redistributed payments.

FOR CDCESs: This Course Qualifies for CE Credit!

To satisfy the requirement for renewal of certification according to the Certification Board for Diabetes Care and Education (CBDCE, www.cbdce.org), courses must relate to diabetes and be part of the list of recognized providers of the CBDCE. The Commission on Dietetic Registration (CDR) is listed as an CBDCE recognized provider. Because Dietitian Central has been granted accreditation by the CDR, it therefore meets the criteria as an approved provider of CEs for CDCESs by the CBDCE. The CBDCE does not directly approve continuing education for any specific webinar or self study course.

Live Event Date: Feb 02, 2023

Expiration Date: May 31, 2024

Performance Indicators/Learning Objectives: 1.6.1, 1.6.2, 9.6.6, 9.6.4

Target Audience: RDs, DTRs, CDCESs

Number of Credits: 2.0

Level(s): 1, 2

Total Cost: 2 Site Credits

About the Presenter: Mary Ann Hodorowicz, RD, CDCES, MBA, Certified Endocrinology Coder

Mary Ann Hodorowicz, RDN, CDE, MBA, Certified Endocrinology Coder owns a corporate consulting practice in Palos Heights, IL, (Mary Ann Hodorowicz Consulting, LLC) that specializes in customized consulting, training, writing and professional presentation services for the healthcare and food industry in these areas:

Diabetes Self-Management Education/Training (DSME/T).
Medical Nutrition Therapy (MNT).
Medicare Diabetes Prevention Program (MDPP).
Medicare Intensive Behavior Therapy for Obesity Benefit.
Diabetes Care Services: Shared Medical Appointments, CGM, CSII, SMBG, Remote Patient Monitoring, Chronic Care Management, Insulin Titration, etc..
Medicare and Private Payer Insurance Reimbursement for above.
Medicare Quality Payment Plan and Merit-based Incentive Payment System (MIPS) For RDNs.
Business Plans (Clinical, Marketing, Operational, Financial and CQI components).
Evidence-Based Standards of Diabetes Care.
Achieving AADE Accreditation or ADA Recognition for DSME/T Programs (requirements and comprehensive turn-key materials, including Policy and Procedure Manual).
E.M.A. Tools for Successful Behavior Change: Motivational Interviewing, Patient Empowerment and Adult Learning Tools.
For Providers Only: Risk Adjustment Payment Methodologies Used by CMS and Select Private Healthcare Insurers.

Mary Ann Hodorowicz is a nationally recognized registered dietitian/nutritionist (RDN), certified diabetes educator (CDE) and certified endocrinology coder (CEC) with a MBA degree (marketing focus). She applies nearly forty years of experience in her work as a consultant, writer, speaker and trainer within her business Mary Ann Hodorowicz Consulting, LLC. Mary Ann is known for her expertise in multiple diabetes care and medical nutrition therapy (MNT) areas; see bulleted list above.

She is especially known for her knowledge on insurance reimbursement, coding and coverage guidelines for diabetes care and MNT interventions. Her clients are in the health, food, pharmaceutical and insurance industries, and include CMS, the CDC, AADE, and multiple state and local departments of public health. Mary Ann has given over 600 presentations, webinars and live training engagements, at which she generously shares her wide array of practice resources. She has written numerous articles in peer-reviewed journals, authored continuing education online modules for AADE, and is a contributing or lead author for multiple toolkits, fact sheets and 'how-to' guides for nutrition and diabetes care professionals on the subjects of insurance reimbursement and creating effective business plans for the sustainability of their services. She served on the AADE Board of Directors from 2013 - 2015.

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