24-1165m Elevate Care: Help Your Patients Prevent the Onset of Type 2 Diabetes
Date: 11/18/24
Refer eligible members to the Medi-Cal Diabetes Prevention Program
Prediabetes is a health condition characterized by blood glucose levels that are higher than normal, but not high enough to be diagnosed as diabetes. Prediabetes increases the risk for type 2 diabetes, heart disease and stroke. If left untreated, up to one-third of people with prediabetes will progress to diabetes within five years. You can help by testing your patients for prediabetes and refer those at risk to the Medi-Cal Diabetes Prevention Program (DPP).
The DPP is a Medi-Cal covered benefit
The Medi-Cal DPP is available to eligible Health Net Medi-Cal members as a covered benefit at no cost to the member.
The Department of Health Care Services (DHCS) established the DPP as a Medi-Cal benefit within the fee-for-service and managed care delivery systems. The program is consistent with the guidelines provided by the Centers for Disease Control and Prevention and incorporates many components of the Centers for Medicare & Medicaid Services DPP in Medicare. For more information, refer to the DHCS website at CMS Diabetes Prevention Program.
How the DPP helps members at risk
The DPP is an evidence-based, lifestyle change program that promotes and focuses on emphasizing weight loss through exercise, healthy eating and behavior modification. The program is designed to assist Medi-Cal beneficiaries diagnosed with prediabetes or at risk for type 2 diabetes in preventing or delaying the onset of type 2 diabetes.
The DPP core benefit lasts one year, and offers 22 peer-coaching sessions as follow:
Session type | Frequency | Description |
Core sessions | 16 weekly | At least 16 sessions over the first 6 months (for months 1 through 6) |
Core maintenance sessions | 6 monthly | At least 1 session per month over the next 6 months (for months 6 through 12) |
Members who achieve and maintain a minimum weight loss of five percent by the end of the year will be eligible to receive ongoing maintenance sessions to help them continue healthy lifestyle behaviors.
Diabetes Care Partners (DCP) will administer the DPP benefit. Eligible members will interact with a health coach via a mobile app and receive weekly online coaching sessions.
DPP eligibility
Medi-Cal members who meet the following DPP eligibility requirements may be referred by physicians or other providers:
- Be enrolled in Medi-Cal.
- Be at least age 18 or older.
- Have a body mass index (BMI) of at least 25 if not identified as Asian; have a BMI of at least 23 if identified as Asian.
- Have had one of the following within 12 months prior to the physician or other provider’s recommendation:
- A hemoglobin A1c test with a value between 5.7% and 6.4%
- A fasting plasma glucose of 100–125 mg/dL.
- A two-hour plasma glucose of 140–199 mg/dL.
- No previous diagnosis of type 1 or type 2 diabetes, excluding gestational diabetes.
How to refer a member for DPP participation
Physicians and other providers can refer members who meet DPP eligibility requirements to the program by completing the online referral form provided on Diabetes Care Partners’ (DCP) website.
You can also call DCP directly at 877-227-3889.
Physicians and other providers can also refer members to call Member Services at 800-675-6110 (TTY: 711) to learn more about the DPP program. Members may contact DCP directly by calling 877-227-3889 or by going online to Diabetes Care Partners’ website and take the eligibility risk assessment to see if they qualify.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by phone or through the Health Net provider portal.
This information applies to Physicians, Participating Physician Groups (PPGs), Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.