CMS Bypasses Telehealth Coverage in Medicare Diabetes Prevention Programs

Federal officials aren’t willing to endorse Medicare coverage for telehealth services in diabetes prevention programs.

As part of the proposed 2022 Physician Fee Schedule released this week, the Centers for Medicare & Medicaid Services has included proposed changes to the Medicare Diabetes Prevention Program (MDPP) expanded model, which focuses on in-person individual and team coaching and support for lifestyle changes that reduce one’s risk of developing type 2 diabetes.

The changes are designed “to make delivery of MDPP services more sustainable and to improve patient access by making it easier for local suppliers to participate and reach their communities,” according to CMS officials. But they don’t include reimbursement for MDPP services delivered by telehealth or via virtual care programs.

Connected health advocates and several lawmakers have been lobbying both CMS and Congress for years to include telehealth coverage. Just last month, dozens of organizations issued a letter of support for a bill before the Senate that would establish Medicare coverage for virtual care services in the MDPP.

“Increasing access to virtual diabetes prevention services is critically important to the health and wellbeing of our nation’s seniors,” the letter stated. “Virtual diabetes prevention models can offer flexibility to engage in sessions at a time most convenient, can increase accessibility by eliminating barriers to care such as childcare and transportation that we know disproportionately affect minority and low-income communities, and include virtual tools for continuous goal setting and tracking.”

The original Diabetes Prevention Program was developed by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), and focused on in-person classes and one-on-one coaching. Based on that model, which is administered by the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services created the National Diabetes Prevention Program for Medicare beneficiaries and launched that program in 2018.

The Medicare Diabetes Prevention Program Expanded Model was launched in 2019 by the Center for Medicare and Medicaid Innovation, but it doesn’t reimburse care providers for using connected health platforms. CMS has argued that they haven’t received enough evidence that virtual care reduces costs or improves outcomes to support Medicare coverage.

CMS officials have in the past said they’ll consider including telehealth and mHealth services, but they have so far steered clear of coverage. The agency is traditionally wary of covering telehealth services without research proving that those services improve clinical outcomes and reduce costs.

Roughly one in every three Americans, or 88 million people, have health characteristics that put them at risk of developing type 2 diabetes, and more than 80 percent don’t even know they’re at risk. Diabetes prevention programs target that population with group and individual treatments that focus on behavior change to support better diet and exercise.