Diabetes Prevention Program: New Medi-Cal Benefit Coming in 2019

January 4, 2019

Effective for dates of service on or after January 1, 2019, the Diabetes Prevention Program (DPP) will be a Medi-Cal covered benefit.

Medi-Cal’s program 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.

Medi-Cal providers choosing to offer DPP services must comply with CDC guidance and obtain CDC recognition in connection with the National Diabetes Prevention Recognition Program. 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, participants 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 DPP curriculum will promote realistic lifestyle changes, emphasizing weight loss through exercise, healthy eating and behavior modification.

DPP Claim Submission Delay
DPP coverage and reimbursement policy is available on the Department of Health Care Services (DHCS) Diabetes Prevention Program web page. Once the necessary California Medicaid Management Information System (CA-MMIS) system edits are complete, this information will be published in the appropriate Part 2 Medi-Cal Update bulletins and provider manuals (see following manual and bulletin information). Then, when instructed, Medi-Cal fee-for-service providers may begin submitting and billing for DPP services. In the interim, Medi-Cal fee-for-service providers are instructed to hold all DPP claims until further notice from the Department.

Medi-Cal Provider Manuals and Bulletins
Health professionals interested in providing DPP services may be new to Medi-Cal’s series of provider manuals and bulletins, which are tailored by types of services rendered. A bulletin is a monthly newsletter. The provider manual is a series of chapters (sections) constantly updated to keep providers educated about policy and billing. Providers may choose any one of the following monthly bulletins to check for DPP articles and policy updates; and later in 2019, the associated provider manual updates:

  • General Medicine
  • Obstetrics
  • Clinics and Hospitals
  • Home Health Agencies/Home and Community-Based Services

Additional Information
To ensure providers stay up-to-date with important DPP information, the Department encourages providers to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to the upcoming changes. Providers may sign up for MCSS by completing the MCSS Subscriber Form.

Questions and comments may be emailed to DHCSDPP@dhcs.ca.gov.