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.​​ 

Ang DPP ay isang nakabatay sa ebidensya, Programa ng pagbabago sa pamumuhay na idinisenyo upang tulungan ang mga benepisyaryo ng Medi-Cal na na-diagnose na may prediabetes sa pagpigil o pagkaantala sa pagsisimula ng type 2 diabetes. Ang mga tagapagbigay ng Medi-Cal na pumipili na mag-alok ng mga serbisyo ng DPP ay dapat sumunod sa patnubay ng CDC at makakuha ng pagkilala sa CDC kaugnay ng National Diabetes Prevention Recognition Programa (DPRP). Ang mga serbisyo ng DPP ay ibibigay sa pamamagitan ng mga sinanay na peer coach na gumagamit ng kurikulum na inaprubahan ng 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.​​ 

Mga anunsyo​​ 

• 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.​​ 

Mga Mapagkukunan ng Estado​​ 

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

• Impormasyon ng DHCS para sa mga bago at kasalukuyang provider: Mga Kinakailangan sa DPP para sa Pagpapatala.​​ 
• Listahan ng mga Inaprubahang DPP Provider.​​ 
• 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.​​ 
• Patakaran sa Saklaw at Reimbursement: Ang mga provider ng Medi-Cal FFS na naaprubahan bilang mga naka-enroll na provider ng DPP ay maaaring magsumite ng mga claim para sa mga serbisyong ibinigay ng DPP. Mangyaring sumangguni sa Medi-Cal Provider Manual para sa DPP para sa impormasyon sa pagsingil at FAQ para sa impormasyon sa pagpapatala.​​  
• Liham ng Lahat ng Plano ng Managed Care:​​  Lahat ng Liham ng Plano 18-018 ay nagbibigay ng patnubay na partikular para sa Medi-Cal Managed Care Plans at hindi inilaan para sa mga provider ng 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.​​  
• Assembly Bill 1810 (Komite sa Badyet, Kabanata 34, Mga Batas ng 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​​ 

Ang mga sumusunod ay nabuong pederal na mga mapagkukunan ng DPP at mga sangguniang materyales para sa mga benepisyaryo at provider:​​ 

• Medicare:​​ 
  • The Final Ruling on Medicare’s DPP (November 2017) – Please see pages 754-1128.​​ 
  • Medicare DPP Expanded Model Fact Sheet​​ 
  • Mapa ng Daan ng Tagatustos ng Medicare DPP​​ 
  • Medicare DPP: Paghahanda na Magpatala bilang isang Medicare DPP Supplier​​ 
  • Medicare DPP Expanded Model Role Fact Sheet​​ 
• CDC:​​ 
  • Mga Pamantayan ng Programa sa Pagkilala sa Pag-iwas sa Diabetes ng CDC at Handbook ng Operating Procedures​​ 
  • Pagsusuri sa Prediabetes ng CDC​​ 
  • Pinipigilan ng CDC ang Type 2 Diabetes​​