Medi-Cal Managed Care (Medi-Cal) members at risk for type 2 diabetes will now have access to the Centers for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP). DPP has been proven by the National Institute of Health (NIH) in a randomized controlled trial to greatly reduce the progression of prediabetes to type 2 diabetes.1 Services are delivered by trained lifestyle coaches and organizations recognized by the CDC.

 

The DPP is a year-long program that consists of weekly sessions with a lifestyle coach for the first six months and monthly maintenance sessions for the latter six months. Sessions can be held in a group classroom setting or online. Participants will learn realistic lifestyle changes, emphasizing weight loss through exercise, healthy eating and behavior modification.

 

Members can determine their eligibility for DPP and enroll through our program administrator, Solera Health,* by visiting www.solera4me.com/AnthemBC_MediCal to take the online assessment or by calling 1‑844‑612‑2949 (TTY 711), Monday through Friday from 6 a.m. to 6 p.m. PT.

 

Criteria for eligibility include:

  • At least 18 years of age.
  • BMI of 25 or greater.
    • If member is of Asian descent, a BMI of 23 or greater is required.
  • Blood screening (optional, if available):
    • Hemoglobin A1C: 5.7% to 6.4%
    • Fasting plasma glucose: 100 to 125 mg/dL
    • Oral Glucose Tolerance Test: 140 to 199 mg/dL
  • Exclusions include no previous diagnosis of end-stage renal disease or type 1 or type 2 diabetes; not pregnant (previous gestational diabetes is not an exclusion).

 

How to become a DPP provider with the Department of Health Care Services (DHCS):

Enrolled Medi-Cal providers should have one of the following provider types and will need to submit the Medi‑Cal Supplemental Changes Form (DHCS 6209) to DHCS for approval:

  • Home health agency
  • Physician group
  • Physician
  • Indian Health services
  • Rural health clinic
  • Community hospital (outpatient)
  • County hospital (outpatient)
  • DPP suppliers

 

Once the eligible Medi-Cal provider is approved to become a DPP provider, the provider will receive a newly established category of service (COS) containing the DPP billing codes, as outlined in the request for outsourcing. Only enrolled and eligible Medi-Cal providers who have the DPP COS may bill for DPP services.2

 

To get started, refer qualified patients today to www.solera4me.com/AnthemBC_MediCal!

 

References:

1 https://www.cdc.gov/diabetes/prevention/prediabetes-type2/preventing.html.

2 https://www.dhcs.ca.gov/services/medi-cal/Documents/DPP_OIL_Enclosure_A_Webpage.pdf.



Featured In:
May 2020 Anthem Blue Cross Provider News - California