Background 

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.

The DPP is an evidence-based, lifestyle change program designed to assist Medi-Cal beneficiaries diagnosed with prediabetes in preventing or delaying the onset of type 2 diabetes. Medi-Cal providers choosing to offer DPP services must comply with CDC guidance and obtain CDC recognition in connection with the National Diabetes Prevention Recognition Program (DPRP). DPP services will be provided through trained peer coaches who use a CDC-approved curriculum.

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.

Announcements

• 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.

State Resources

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

• DHCS information for new and existing providers: DPP Requirements for Enrollment.
• List of Approved DPP Providers.
• 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.
• Coverage and Reimbursement Policy: Medi-Cal FFS providers who have been approved as enrolled DPP providers may submit claims for DPP services provided. Please refer to the Medi-Cal Provider Manual for DPP for billing information and the FAQ for enrollment information. 
• Managed Care All Plan Letter: All Plan Letter 18-018 provides guidance specifically for Medi-Cal Managed Care Plans and is not intended for Medi-Cal DPP providers.
• 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. 
• Assembly Bill 1810 (Committee on Budget, Chapter 34, Statutes of 2018)
• Senate Bill 97 (Committee on Budget, Chapter 52, Statutes of 2017)
• If you have any questions about Medi-Cal’s DPP, please email: medi-cal.benefits@dhcs.ca.gov. 

Federal Resources

The following are federally generated DPP resources and reference materials for beneficiaries and providers:

• Medicare:
  • The Final Ruling on Medicare’s DPP (November 2017) – Please see pages 754-1128.
  • Medicare DPP Expanded Model Fact Sheet
  • Medicare DPP Supplier Road Map
  • Medicare DPP: Preparing to Enroll as an Medicare DPP Supplier
  • Medicare DPP Expanded Model Roles Fact Sheet
• CDC:
  • CDC Diabetes Prevention Recognition Program Standards and Operating Procedures Handbook
  • CDC Prediabetes Screening Test
  • CDC Preventing Type 2 Diabetes