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

Attorney Barbara J. Zabawa started the Center for Health & Wellness Law, LLC after she recognized a need for legal services that shared a mission with providers to improve patient outcomes and population health, encourage wellness, protect patient interests in choice of provider and treatment options, provide holistic care, and expand information access. Attorney Zabawa has 20+ years of experience in the health care field, first receiving her Master's in Public Health from the University of Michigan before attending law school at UW Madison, where she graduated with honors in 2001. From 2003-2005, Ms. Zabawa clerked for the Honorable Barbara B. Crabb in the United States District Court for the Western District of Wisconsin and worked on a variety of matters, including employment, patent infringement, civil rights, and contract matters. She also served as a Skadden Fellow representing health care consumers on both the national and local level by helping consumers navigate private insurance coverage issues and advocating for their interests as a Funded Consumer Advocate at the National Association of Insurance Commissioners (NAIC). Attorney Zabawa has worked for a large health insurance company providing advice on the Affordable Care Act as well as HIPAA Privacy and Security compliance. In addition, she was in private practice at a large regional law firm for seven years, where she was a shareholder, led her firm's health care team and served as its HIPAA Privacy Officer. While in private practice, she handled a variety of health law matters, such as compliance with fraud and abuse laws, professional scope of practice matters, state licensing issues, HIPAA privacy and security compliance, Medicare and Medicaid reimbursement and conditions of participation compliance, Accountable Care Organization and other joint venture agreements, employment agreements, as well as business litigation. Attorney Zabawa is the author of the forthcoming book "Rule the Rules of Workplace Wellness Programs." She is a frequent speaker and writer both nationally and regionally on workplace wellness program compliance, the Affordable Care Act, fraud and abuse issues and HIPAA compliance. She has published several law review articles in the practice of health law and has been interviewed by TV, radio and print media regarding wellness, health reform, and HIPAA. She is a Board Member for Rogers Memorial Hospital Foundation, Board President for the Wisconsin Alliance for Women's Health, Board Member for Health Promotion Advocates, and currently serves on the Oversight Advisory Council for the Wisconsin Partnership Program and the State Bar Health Law Section Board. Education JD - University of Wisconsin Law School, cum laudeMPH - University of Michigan School of Public HealthBA - Lawrence University Admitted to Practice: • New York• Wisconsin• Federal District Court of the Western District of Wisconsin• Federal District Court of the Eastern District of Wisconsin• Court of Appeals for the Seventh Circuit• United States Supreme Court


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