MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapter II, Section 71, National Diabetes Prevention Program
Maine Department of Health & Human Services sent this bulletin at 11/08/2023 08:00 AM EST
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Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, MaineCare Benefits Manual (MBM), Chapter II, Section 71, National Diabetes Prevention Program
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
This adopted rule establishes MaineCare Benefits Manual Chapter II, Section 71, National Diabetes Prevention Program (NDPP) Services, which allows MaineCare to reimburse providers for delivering the National Diabetes Prevention Program Lifestyle Change Program (National DPP LCP).
The National DPP LCP is an evidence-based, intensive lifestyle behavior change program designed and overseen by the United States Centers for Disease Control and Prevention (CDC) to teach participants the skills to change and maintain physical activity levels and dietary habits to prevent or delay type 2 diabetes. Members are eligible for the National DPP LCP when they have a qualifying body mass index in addition to a positive screening for prediabetes or a qualifying blood test. To enroll as a MaineCare National DPP LCP Provider (Provider), providers must have recognition awarded by the CDC’s Diabetes Prevention Recognition Program (DPRP) and adhere to the “Centers for Disease Control and Prevention Diabetes Prevention Recognition Program Standards and Operating Procedures,” (DPRP Standards) published by the CDC on May 1, 2021 (OMB No. 0920-0909, Exp. Date: 04/30/2024), which outlines provider requirements for delivering the National DPP LCP. The DPRP Standards are incorporated by reference in the rule and are available on the CDC’s National DPP webpage at: https://www.cdc.gov/diabetes/prevention/requirements-recognition.htm.
The National DPP LCP is comprised of twenty-two sessions delivered over the course of one year, and Providers must use the CDC’s PreventT2 Curriculum or another CDC-approved curriculum. The first sixteen core sessions occur during the first six months and the final six maintenance sessions occur monthly during the last six months. Trained lifestyle coaches deliver sessions in-person and/or via telehealth for approximately sixty minutes per session. The allowed amount for each session is 100% of Medicare’s current total reimbursement for all sessions without weight loss included in the Medicare Diabetes Prevention Program (MDPP), divided by the total number of sessions required by the DPRP Standards.
Providers are eligible for two performance payments if members achieve weight loss or HbA1C goals. The allowed amount for each performance payment is 100% of Medicare’s current maximum reimbursement for payments related to weight loss included in the MDPP, divided by two.
This rulemaking complies with P.L. 2021, Ch. 639, An Act to Codify MaineCare Rate System Reform, codified in 22 M.R.S. Sec. 3173-J. The Department issued a Rate Determination Initiation Notice on December 16, 2022. The Department held a public rate forum on February 6, 2023, to collect stakeholder input and comments to inform the Rate Determination for the NDPP and accepted written comments through February 27, 2023. The Department published responses to comments on April 25, 2023, which it then updated on August 22, 2023 to reflect final changes to the reimbursement methodology.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: November 8, 2023
STATUTORY AUTHORITY: 22 MRS §§ 42, 3173; P.L. 2021, Ch. 398, Part A, Sec. A-17; 22 M.R.S. 3173-J
AGENCY CONTACT PERSON: Henry Eckerson, Children’s and Behavioral Health Policy Manager
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
EMAIL: henry.eckerson@maine.gov
TELEPHONE: (207)-624-4045 FAX: (207)-287-6106
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