糖尿病預防專案
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 是一項基於證據的生活方式改變專案，旨在幫助被診斷患有糖尿病前期的加州醫療補助健康保健計劃受益人預防或延緩 2 型糖尿病的發病。 選擇提供 DPP 服務的加州醫療補助健康保健計劃提供者必須遵守 CDC 指導，並獲得 CDC 與國家糖尿病預防認可專案 (DPRP) 相關的認可。 DPP 服務將通過受訓練的同行教練提供，他們使用 CDC 認可的課程。
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.
國家資源
The following are state-generated resources and reference materials for beneficiaries and providers regarding Medi-Cal’s DPP benefit:
- 針對新的和現有提供者的 DHCS 資訊： DPP 註冊要求。
- 核准的 DPP 提供者清單。
- 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.
- 承保範圍和報銷政策：已被批准為註冊 DPP 提供者的加州醫療補助健康保健計劃FFS提供者可以針對所提供的 DPP 服務提出索賠。 請參閱《加州醫療補助健康保健計劃提供者手冊》以了解帳單資訊和常見問題以了解註冊資訊。
- 管理護理所有計劃信件： 所有計劃信函 18-018專門針對Medi-Cal Managed Care計劃提供指導，不適用於加州醫療補助健康保健計劃 DPP 提供者。
- 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.
- 《1810 年議會條例草案》(財政預算委員會 2018 年第 34 章程)
- 第 97 年參議院條例草案 (財政預算委員會 2017 年第 52 章規程)
- If you have any questions about Medi-Cal’s DPP, please email: medi-cal.benefits@dhcs.ca.gov.
聯邦資源
以下是聯邦生成的 DPP 資源和受益人和提供者的參考材料：
- 聯邦醫療保險：
- 疾病控制中心：