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Medicare unveils Diabetes Prevention Program

March 24, 2016
by Nicole Stempak, Senior Editor
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The Obama administration observed the sixth anniversary of the Affordable Care Act (ACA) and Diabetes Alert Day by unveiling a plan to expand Medicare coverage for the millions at risk of developing diabetes.

Under the proposed plan, Medicare would pay for certain lifestyle change that could help prevent Type 2 diabetes, including having trained counselors coach people to develop healthier eating habits and increase physical activity.

In 2011, the Centers for Medicare & Medicaid Services (CMS) awarded the National Council of Y.M.C.A.s nearly $12 million to enroll prediabetic beneficiaries in a 15-month Diabetes Prevention Program. Participants lost on average about 5 percent of their body weight, enough to substantially reduce their risk of future diabetes.

"This program has been shown to reduce healthcare costs and help prevent diabetes, and is one that Medicare, employers and private insurers can use to help 86 million Americans live healthier," says Sylvia Mathews Burwell, secretary for the Department of Health and Human Services, in a statement.

The Centers for Disease Control and Prevention estimates about 30 million Americans have Type 2 diabetes and that 86 million adults, including at least 22 million people 65 and older, have prediabetes. Prediabetes is treatable, but officials say only about 10 percent of people are aware they have the condition, which increases risk for heart disease, stroke and Type 2 diabetes.

The independent Office of the Actuary in the CMS certified the expansion of the program would save money and improve health. Medicare estimated savings of $2,650 for each program enrollee compared with similar beneficiaries not enrolled, more than enough to cover program costs.

This is the first-ever preventive service model eligible for expansion under Medicare and is possible through a provision in the ACA that allows the health secretary to expand projects if she finds they would reduce Medicare spending without reducing the quality of care, and if the Medicare actuary agrees. The proposal must go through a public comment period but would not require congressional approval.

More information about how Diabetic Prevention Program services would be expanded, delivered and funded will be included in the CY 2017 Medicare Physician Fee Schedule proposed due out this summer.

Medicare currently provides coverage of the following diabetes-related services for qualified beneficiaries: diabetes screening tests, diabetes self-management training (DSMT), medical nutrition therapy (MNT), glaucoma screening and diabetes supplies and other services.

Read the full announcement, the CMS Office of the Actuary certification of the Diabetes Prevention Program and independent evaluation report here

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