The following resources are for CCOs and primary care teams to support work to prevent diabetes at both the system and clinic levels. Effective January 1, 2019, the National Diabetes Prevention Program (National DPP) is a Medicaid and Medicare covered benefit in Oregon. Information about the program and benefit coverage in Oregon are below.
About prediabetes
It is estimated that 86 million Americans (one in three) have prediabetes. A person with prediabetes has a blood sugar level higher than normal, and their risk for developing type 2 diabetes is increased. People with type 2 diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of type 2 diabetes. Investing in type 2 diabetes prevention can slow or prevent the development of the disease in adults with prediabetes, resulting in reduced costs and healthier populations.
National Diabetes Prevention Program
The National Diabetes Prevention Program is an in-person or virtual evidence-based lifestyle change program developed by the Centers for Disease Control and Prevention (CDC) for preventing type 2 diabetes. The year-long program helps participants learn ways to incorporate healthier eating and moderate physical activity, as well as problem-solving, stress-reduction and coping skills into their daily lives. Participants meet with a trained lifestyle coach and a small group of people who are making lifestyle changes to prevent diabetes. Sessions are weekly for the first six months and then at least monthly for the next six months. This proven program can help people with prediabetes and/or at risk for type 2 diabetes make achievable and realistic lifestyle changes and cut their risk of developing type 2 diabetes by 58 percent.
Resources
For individuals
For health care providers
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Steering Toward Health – Health care providers can download ready-to-use patient education materials to give to their patients and to educate their care teams.
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Statewide Self-Management Program Locator – Find health education and health-management classes or programs for your patients through this statewide program locator. Includes National Diabetes Prevention Program.
For Diabetes Prevention Program providers
For CCOs, employers and insurers
- Webinar: National DPP 101
- Topics: key program elements necessary for payment including member/patient eligibility, program modalities, current program providers and their credentials, and CDC-recognition.
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Slides / Recording (10/24/23)
- Webinar: Billing Medicaid for National DPP Payment
- Topics: DPP billing cadence and rates, diagnosis codes, rendering and supervising providers, and the two provider types to bill under
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Slides / Recording (11/7/23)
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2023 DPP Companion Guide for Coordinated Care Organizations and Health System Partners Serving Oregon Health Plan Members
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Implementing Comprehensive Diabetes Prevention Programs: A Guide for CCOs – Oregon-specific resource, informed by lessons learned from Oregon CCOs participating in the National DPP Medicaid Demonstration Project (2016–2018)
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DPP FAQ (OHA, July 2024)
- Webinar: Enrollment Process for National DPP Providers: Slides / Recording
- DPP case studies
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National DPP Coverage Toolkit – Information on topics such as contracting, delivery, billing and coding, and data and reporting that are designed to support health insurance plans, employers, and state Medicaid agencies in making the decision to cover the National DPP lifestyle change program
- Oregon Health Plan DPP payment requirements are described in Guideline Note 179 and Guideline Note 5 of Oregon’s searchable Prioritized List of Health Services.
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National Diabetes Prevention Program reimbursement for Oregon Health Plan members (OHA Health Systems Division)
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Health-related services FAQ guidance (OHA Health Policy and Analytics)
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Steering Toward Health – Download ready-to-use patient education flyers.