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Diabetes Prevention Works and Medicare is Expanding the Program!

Posted by Barbara J. Zabawa | Sep 01, 2016 | 0 Comments

In 2011 the YMCA received a Health Care Innovation Award grant from the Centers for Medicare and Medicaid Services (CMS) to expand its diabetes prevention program to prediabetic Medicare recipients.  The program consists of 16 weekly sessions followed by 8 monthly maintenance sessions.  Sessions are led by a lifestyle coach at 17 YMCA locations across the U.S.  The program aims to improve health and reduce medical spending by stimulating weight loss of at least 5% of body weight and increasing physical activity to 150 minutes per week.

The YMCA program started enrolling Medicare recipients in 2013 and within two years, showed significant evidence of success.  Among those who completed at least 4 sessions, weight loss averaged 5.09 kg at 4 to 6 months and 5.31 kg at a year.  According to a recent article about the diabetes prevention program, the success of the program in helping enrollees lose more than 5 kg of weight shows that it is feasible to stimulate weight loss in a relatively inexpensive community-based program offered in multiple location by staff without advanced training.  The program was also able to save the Medicare program money – approximately $1780/year per member. 

Because of this success, CMS announced on July 7, 2016 that it intends to expand the diabetes prevention program by January 1, 2018.  CMS is seeking comments on the proposed expansion until September 6, 2016.  The comments CMS would find helpful relate to whether persons who deliver diabetes prevention program services need to obtain a national provider identification number and enroll in Medicare, how to tie payment to the services delivered, how providers of the services should submit claims to CMS for payment, who should qualify as a pre-diabetic patient, among other comments.  You can learn more about the comment process here.

Those who work in health promotion or health education should use this opportunity to weigh in on the expansion.  The expansion of the diabetes prevention program nationwide by 2018 could provide those who work in wellness coaching and education with another opportunity to deliver services.  CMS will reimburse qualified service providers around $630 in a 2-year period for helping Medicare enrollees who are at risk for diabetes to stay healthy.  The expansion of the diabetes prevention program could provide a possible source of sustainable funding for health promotion professionals who can improve health and save money for people who do not have access to programs through their employers.

If you would like help in submitting comments to CMS regarding this program expansion, contact the Center for Health and Wellness Law, LLC.  We would be happy to assist.

About the Author

Barbara J. Zabawa

Barbara is lead author of the book Rule the Rules on Workplace Wellness Programs, published by the American Bar Association. She is a frequent writer and speaker on health and wellness law topics, having presented for national organizations such as WELCOA, National Wellness Institute, HPLive, Healthstat University and HERO. Barbara J. Zabawa is a Clinical Assistant Professor for the University of Wisconsin Milwaukee College of Health Sciences, Department of Health Services Administration where she teaches graduate and undergraduate courses in health law and compliance, US health care delivery and health professions career development. Barbara also owns the Center for Health and Wellness Law, LLC a law firm dedicated to improving legal access and compliance for the health and wellness industries.  Before graduating with honors from the University of Wisconsin Law School, she obtained an MPH degree from the University of Michigan. Immediately prior to starting her own firm, she was Associate General Counsel and HIPAA Privacy Officer for a large health insurer where she advised on Affordable Care Act matters. She was also a shareholder and Health Law Team Leader at a large Wisconsin law firm. Barbara serves health and wellness professionals and organizations across the country as an advocate, a transactional lawyer and a compliance resource. Her commitment to improving health and wellness also shows through her community service. Barbara founded the Wellness Compliance Institute, a nonprofit organization that seeks to improve wellness program and activity compliance. She also is a Board Member for the Rogers Memorial Hospital Foundation, a health care organization that specializes in treating mental illness and she chairs the State Bar of Wisconsin Health Law Section. Barbara is licensed to practice law in both Wisconsin and New York.

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