New Bill Would Add Telehealth to Medicare Diabetes Prevention Program

A group of Senators has introduced a bill that would expand access to the Medicare Diabetes Prevention Program through telehealth.

S 4709 was introduced this week by Senators Tim Scott (R-SC), Mark Warner (D-VA), Kevin Cramer (R-ND), Kyrsten Sinema (D-AZ), Tom Cotton (R-AR) and Tina Smith (D-MN). Titled the PREVENT Diabetes Act, it addresses a long-standing issue with a Medicare program designed to help members at increased risk of developing type 2 diabetes.

"It’s no secret that diabetes is a disease that has disproportionately affected minority communities across the country,” Warner said in a press release. “To ensure that all individuals have the tools needed to combat this preventable disease, the Prevent Diabetes Act would help expand access to virtual classes under the existing Medicare Diabetes Prevention Program. This commonsense and cost-saving expansion will ensure that more Americans at-risk of developing diabetes who are living in either rural or medically underserved communities, can participate in this critical program that has been proven to delay the full onset of this preventable disease.”

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.

But the Medicare Diabetes Prevention Program Expanded Model conducted by the Center for Medicare and Medicaid Innovation doesn’t reimburse care providers for using connected health platforms. Telehealth and mHealth advocates have been lobbying for years to add those services, saying a virtual platform would reach far more people at risk and enable providers to make better use of limited resources.

More than 70 healthcare providers are now listed on the CDC’s DPP website, though only a handful have been recognized as offering proof that their online programs reach recognized benchmarks for activity and weight loss. A growing number of programs are using virtual care as a means of expanding the program’s reach and making the most of limited resources, and they’re asking CMS to cover those services.

Last year, a group of Senators – including those sponsoring the Prevent Diabetes Act – wrote a letter to Health and Human Services Secretary Alex Azar and CMS Administrator Seema Verma asking that the program be expanded to include CDC-recognized virtual DPP providers.

“Virtual delivery of MDPP has the ability to empower beneficiaries to access MDPP regardless of where they live, and in the format of their choosing,” the Senators wrote. “Because of the outcome-focused reimbursement structure, CMS has insulated from reimbursing for ineffective treatment. Medicare Advantage plans have also been vocal in their desire to deploy virtual DPP for their beneficiaries. Given this, we also encourage CMS to consider ways for Medicare Advantage plans to use virtual providers to ensure that all Medicare beneficiaries have access to a CDC fully-recognized DPP.”

In April, that same group lobbied again for the inclusion of virtual care providers, saying the coronavirus pandemic has created further barriers to in-person care.

The new bill, which as of September 25 contains no text or summary, is supported by several organizations, including the American Diabetes Association, American Medical Association, Connected Health Initiative and National Kidney Foundation, along with digital health companies Livongo, Noom and Omada Health.