Priority Health reimburses providers for offering Diabetes Prevention Programs (DPP). Providers must be contracted to provide services to Priority Health members. Here are additional requirements for providers.
Requirements for individual and group commercial programs
Providers must offer a Diabetes Prevention Recognized Program (DPRP) or their program must be pending recognition from the Centers for Disease Control and Prevention (CDC).
Requirements for Medicare programs
To offer the Medicare Diabetes Prevention Program (MDPP) for Medicare members, providers must be enrolled as a supplier which includes CDC preliminary recognition status.
Providers must notify Priority Health within ten business days if the CDC National Diabetes Prevention Program recognition or MDPP supplier status is revoked.
Participating provider responsibilities
- Partner directly with the Priority Health DPP Program Manager to ensure correct set-up and processes for sustainability and reimbursement.
- Conduct DPP programs that meet the CDC or CMS criteria.
- Educate PCPs and staff about the program and the referral process as requested by Priority Health.
- Maintain a course calendar on the State of Michigan registry, www.mihealthyprograms.org, showing current DPP course offering schedules and locations.
- Manage registration and class rosters.
- Offer an informational sessions for prospective participants to enhance program interest.
- Provide program materials such as: leader manuals, participant manuals, scales, calorie count books, food trackers.
- Secure location for all sessions
- Share results with Priority Health.
- Help raise awareness about prediabetes in the communities you serve.
Priority Health will outreach to members twice a year to assist with increasing awareness of prediabetes and the DPP. (January and August)
Data management and submission requirements
Providers must maintain a data base that is compliant with CDC expectations for the NDPP program.
Providers must submit individual level member data files to Priority Health through an established electronic standardized process (SFTP) using the formatting provided by Priority Health.
Providers must report all data and outcomes from each class:
- After class one for baseline
- At completion of 16 week core session period
- At completion of core maintenance period (1 year).
Member level data must include:
- Member ID number
- Date of birth
- DPP provider organization name
- Enrollment date
- Program location
- Initial weight at first session
- Weight and number of core sessions attended at the end of the core session period
- Weight and number of monthly sessions attended at completion of one (1) program year
- During year 2 ongoing maintenance sessions quarterly reporting of weight and attendance
Communications and promotional materials
Providers shall not publish any materials, including press releases, advertisements and other promotional materials, without prior written consent from Priority Health when using our name or logo. Secure Priority Health approval on all communications for:
- Media, social media and working with public policy officials
- Media stories of successful outcomes highlighting our commitment to diabetes prevention
- Any printed materials, spoken scripts, or presentations referencing Priority Health
Lifestyle Coach requirements
To be reimbursable, DPP programs must be lead by a certified lifestyle coach. Lifestyle coaches must be certified in [NDPP what is this? We need to define.] training.
A trained Lifestyle Coach works with groups of participants to:
- Lose 5-7% of their starting body weight
- Adopt healthy eating habits
- Be physically active with a weekly goal of 150 minutes of activity/exercise
- Learn to recognize and overcome barriers to healthy eating and physical activity
- Lower medication usage
- Improve chronic disease risk factors
[Where can providers find a lifestyle coach and what kind of certification or training are they required to have?]