Prevención de la diabetes Program
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California state law requires the Department of Health Care Services (DHCS) to establish the Diabetes Prevention Program (DPP) as a Medi-Cal covered benefit. Medi-Cal’s DPP benefit will be consistent with the federal Centers for Disease Control and Prevention’s (CDC’s) guidelines and will also incorporate many components of the Centers for Medicare & Medicaid Services’ (CMS’) DPP in Medicare.
El DPP es un programa de cambio de estilo de vida basado en la evidencia diseñado para ayudar a los beneficiarios Medi-Cal diagnosticados con prediabetes a prevenir o retrasar la aparición de la diabetes tipo 2. Medi-Cal proveedores que opten por ofrecer servicios de DPP deben cumplir con la guía de los CDC y obtener el reconocimiento de los CDC en relación con el Program Nacional de Reconocimiento para la Prevención de la Diabetes (DPRP). Los servicios de DPP se proporcionarán a través de entrenadores de pares capacitados que utilizan un plan de estudios aprobado por los CDC.
Medi-Cal’s DPP will include a core benefit consisting of at least 22 peer-coaching sessions over 12 months, which will be provided regardless of weight loss. In addition, beneficiaries who achieve and maintain a required minimum weight loss of 5 percent from the first core session will also be eligible to receive ongoing maintenance sessions, after the 12-month core services period, to help them continue healthy lifestyle behaviors. The CDC’s DPP curriculum promotes realistic lifestyle changes, emphasizing weight loss through exercise, healthy eating and behavior modification.
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- On September 28, 2021, DHCS held a stakeholder meeting to discuss changes to the regulatory bulletin entitled, “Updated Medi-Cal Enrollment Requirements and Procedures for Diabetes Prevention Programs.”
- Beginning February 4, 2022, pharmacies that submit an application for enrollment can report providing DPP services in their primary application, and currently enrolled pharmacies can report providing these services by submitting a supplemental change form. The application for enrollment and supplemental change form must be submitted through the PAVE Portal.
- Additionally, in accordance with the Centers for Medicare & Medicaid Services’ Calendar Year 2022 Physician Fee Schedule Final Rule, DPP providers are no longer considered institutional providers. Therefore, all applications received on or after January 1, 2022, will no longer require an application fee.
Recursos Estatales
The following are state-generated resources and reference materials for beneficiaries and providers regarding Medi-Cal’s DPP benefit:
- Información de DHCS para proveedores nuevos y existentes: Requisitos de DPP para la inscripción.
- Lista de proveedores de DPP aprobados.
- DHCS and CDPH presented information about the Medi-Cal DPP benefit at the quarterly Prevent Diabetes STAT webinar on February 25, 2019: PowerPoint Slides.
- Frequently Asked Questions: DHCS’ responses to commonly asked questions regarding Medi-Cal’s DPP benefit.
- Póliza de Cobertura y Reembolso: Los proveedores de FFS de Medi-Cal que han sido aprobados como proveedores de DPP inscritos pueden presentar reclamaciones por los servicios de DPP prestados. Consulte el Manual del proveedor de Medi-Cal para DPP para obtener información de facturación y las preguntas frecuentes para obtener información sobre la inscripción.
- Carta de todos los planes de atención administrada: Toda la Carta del Plan 18-018 proporciona orientación específica para los Planes Medi-Cal Managed Care y no está destinada a los proveedores de Medi-Cal DPP.
- DPP Curriculum Translations: The National Association of Chronic Disease Director’s National DPP Coverage Toolkit now includes the National DPP Curriculum and its various translations. You can also view and download the CDC-developed and approved PreventT2 Curriculum and accompanying handouts, available in English or Spanish on CDC’s National Diabetes Prevention Program website.
- Proyecto de Ley 1810 de la Asamblea (Comité de Presupuesto, Capítulo 34, Estatutos de 2018)
- Proyecto de Ley del Senado 97 (Comité de Presupuesto, Capítulo 52, Estatutos de 2017)
- If you have any questions about Medi-Cal’s DPP, please email: medi-cal.benefits@dhcs.ca.gov.
Recursos Federales
Los siguientes son recursos del DPP generados por el gobierno federal y materiales de referencia para beneficiarios y proveedores:
- Medicare:
- The Final Ruling on Medicare’s DPP (November 2017) – Please see pages 754-1128.
- Hoja informativa del modelo ampliado de Medicare DPP
- Hoja de ruta para proveedores de Medicare DPP
- Medicare DPP: Preparación para inscribirse como proveedor de Medicare DPP
- Hoja informativa sobre las funciones del modelo ampliado de Medicare DPP
- CDC: