Proposed Diabetes-Prevention Model Introduced by CMS


    On Thursday, the Centers for Medicare and Medicaid Services proposed expanding a program aiming at helping people avoiding diabetes. Adding to the slew of proposed changed to Medicare’s policies, the CMS suggested starting up the program in 2018, seeking comment whether to extend the effort nationally or in additional select markets. The program first launched in 2013, enrolling beneficiaries in eight states: Arizona, Delaware, Florida, Indiana, Minnesota, New York, Ohio, and Texas.

    It is the first project from the CMS Innovation Center, granted by the Affordable Care Act, to prove to be successful enough to be rolled out to the full Medicare program. Services offered include lifestyle intervention, physical activity, and coaching, all with the goal of preventing the onset of diabetes in prediabetic individuals. People with higher than normal blood sugar levels were enrolled and attended weekly training sessions on nutrition, exercise and overall healthy living. Those who attended at least four sessions reduced their body weight by about 5%. Medicare estimated a savings of $2,650 per participant, extending beyond the cost of the program. Providers would be paid according to the number of sessions attended as well as to how a patient achieves and maintains a minimum weight loss.

    Another key proposal in physical fee schedule rule will update the quality measures used for the Medicare Shared Savings Program to protect beneficiaries when care organizations waive the rule requiring patient hospitalization at least three days before Medicare will reimburse care at a nursing facility. The CMS is also proposing to require healthcare providers and suppliers to be screened in Medicare in an effort to contract with a Medicare Advantage organization, creating consistency with CMS’ healthcare providers and supplier enrollment requirements.

    The rule contains proposals to increase payments for routine office visits for patients with mobility-related disabilities. Currently, Medicare pays approximately $73 for these visits, even though the patient might need to spend more time with the physician or require more physical support. Now it’s proposed that Medicare would pay approximately $119 for the visit.

    Comments on the physician fee schedule will be accepted through Sept. 6, 2016.


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