糖尿病预防计划
背景
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 是一项基于证据的生活方式改变计划，旨在帮助被诊断为糖尿病前期的 Medi-Cal 受益人预防或延缓 2 型糖尿病的发作。 选择提供 DPP 服务的 Medi-Cal 提供商必须遵守 CDC 指导并获得与国家糖尿病预防认可计划 (DPRP) 相关的 CDC 认可。 DPP 服务将通过经过培训并使用 CDC 批准课程的同伴教练提供。
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.
公告
- 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.
州资源
The following are state-generated resources and reference materials for beneficiaries and providers regarding Medi-Cal’s DPP benefit:
- 新老供应商的 DHCS 信息： DPP 注册要求。
- 经批准的 DPP 提供商列表。
- 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.
- 承保范围和报销政策：已获批准为注册 DPP 提供商的 Medi-Cal FFS 提供商可以提交所提供的 DPP 服务的索赔。 请参阅Medi-Cal 提供商手册中的 DPP 了解账单信息，并参阅常见问题解答了解注册信息。
- 管理式医疗全计划信函： 所有计划信函 18-018专门为 Medi-Cal 管理式医疗计划提供指导，并不适用于 Medi-Cal DPP 提供商。
- 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.
- 议会法案 1810（预算委员会，2018 年法规第 34 章）
- 参议院第 97 号法案（预算委员会，2017 年法规第 52 章）
- If you have any questions about Medi-Cal’s DPP, please email: medi-cal.benefits@dhcs.ca.gov.
联邦资源
以下是联邦政府为受益者和提供者生成的 DPP 资源和参考资料：
- 医疗保险：
- CDC：