Tsev Cov Kev Pabcuam Cov Kev Pabcuam Medi-Cal Kev Pab Cuam Tiv Thaiv Kab Mob Ntshav Qab Zib​​ 

Kev Tiv Thaiv Mob Ntshav Qab Zib​​ 

Keeb kwm​​  

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.​​ 

DPP yog ib qho pov thawj-raws li qhov kev pab cuam hloov txoj kev ua neej uas tsim los pab Medi-Cal cov neeg tau txais txiaj ntsig tau kuaj pom tias muaj ntshav qab zib hom 2 hauv kev tiv thaiv lossis ncua qhov pib mob ntshav qab zib hom 2. Cov kws kho mob Medi-Cal xaiv muab cov kev pabcuam DPP yuav tsum ua raws li CDC cov lus qhia thiab tau txais CDC lees paub nrog rau National Diabetes Prevention Recognition Program (DPRP). DPP cov kev pabcuam yuav muab los ntawm cov kws qhia ua phooj ywg uas tau txais kev cob qhia uas siv CDC-pom zoo cov ntaub ntawv kawm.​​ 

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.​​ 

Kev tshaj tawm​​ 

  • 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.​​ 

Xeev cov peev txheej​​ 

The following are state-generated resources and reference materials for beneficiaries and providers regarding Medi-Cal’s DPP benefit:​​ 

Federal Resources​​ 

Cov hauv qab no yog tsoomfwv tsim DPP cov peev txheej thiab cov ntaub ntawv siv rau cov neeg tau txais txiaj ntsig thiab cov chaw muab kev pabcuam:​​