Amends title XVIII of the Social Security Act to cover the Medicare Diabetes Prevention program.
Defines “diabetes prevention program services” as structured sessions aimed at preventing or delaying type II diabetes, following a CDC-approved curriculum, and available to eligible individuals from January 1, 2025.
Eligible individuals are those entitled to part A and enrolled under part B of Medicare, with no previous diabetes diagnosis (except gestational diabetes), without end-stage renal disease, and meeting additional criteria specified by the Secretary.
Removes any lifetime limit on participation for eligible individuals in the diabetes prevention program.
Specifies that diabetes prevention program services not furnished to eligible individuals will not be covered.
Introduces the term “diabetes prevention program supplier” as an entity recognized under the CDC’s Diabetes Prevention Recognition Program, enrolled under the program, and meeting certain requirements including administrative, documentation, data submission, and inspection standards.
Establishes a payment structure for diabetes prevention program services, with payments to suppliers for services furnished to eligible individuals, updated annually based on the Consumer Price Index.
Allows for the termination of participation by a diabetes prevention program supplier if an individual is no longer eligible, with requirements for documentation supporting such termination.
Continues the standards of the Medicare Diabetes Prevention Program Expanded Model, except as specified otherwise, to govern the diabetes prevention program.
Ends payments for services under the Medicare Diabetes Prevention Program Expanded Model after January 1, 2025.
Requires the Secretary of Health and Human Services to update relevant regulations by November 30, 2024, in accordance with the amendments.
Mandates a report by January 1, 2028, on the impact of the diabetes prevention program, including participation rates, weight loss, health outcomes, and the effect on type 2 diabetes diagnoses and costs.