Expanded Illinois Medicaid coverage for diabetes prevention and management programs

Springfield, Illinois (WIFR)-Public Health Service, Illinois and Healthcare and Family Services, Illinois, Diabetes Prevention Program and Diabetes Self-Management Education and Support Program will eventually be newly targeted for Medicade in Illinois I announced that. Federal approval.

The Diabetes Prevention Program (DPP) includes evidence-based, one-year lifestyle changes aimed at reducing the risk of prediabetes adults developing type 2 diabetes. Developed by the CDC, this program’s diabetes prevention lifestyle change curriculum focuses on increased physical activity, a healthy diet, and stress management.

A CDC-certified DPP organization is eligible to register as an Illinoi Medicaid Provider and manage services during regular sessions throughout the year, including dietary and nutritional counseling, fitness assessments, and educational sessions on how to prevent type 2 diabetes. We can offer the program to various participants.

A CDC assessment of DPP found a 58% reduction in the risk of developing type 2 diabetes.

To qualify for the DPP program, you must be 18-64 years old, enroll in the Medicaid, Illinois program, have a body mass index (BMI) above a certain level, have elevated blood sugar levels, or have a medical history. is needed. Of gestational diabetes. Registrants who have previously been diagnosed with type 1 or type 2 diabetes or are currently pregnant are not eligible to participate in the program.

“Diabetes is a serious chronic illness that can lead to heart disease, stroke, blindness, kidney failure, amputation of the lower extremities, and even premature death,” said Dr. Ngozi Ezike, director of public health in Illinois. “The proportion of new cases of diabetes between children and adolescents continues to grow, and diabetes-related complications are increasing between the ages of 18-64. However, improved diet, more physical activity, And with behavioral support, growth can be slowed or stopped. And now, with Medicade’s coverage of diabetes prevention and management programs in Illinois, our goal is to make more people healthier. Get the support and support you need to live a good life. “

Healthcare providers and the Medicaid Managed Care Organization (MCO), Illinois can refer participants to the program, but they do not need to be referred to participate. Eligible registrants can register directly with a service fee or a CDC-certified DPP provider within the MCO’s network by providing blood test results within the last year indicating a diagnosis of pre-diabetes or gestational diabetes.

The second program, Diabetes Self-Management Education and Support (DSMES), provides services to prevent the progression of diabetes and promote a healthier lifestyle.

DSMES must be recommended by a healthcare provider or practitioner who is authorized to work with an individual to stop the progression of diabetes. Services may include long-term dietary changes and nutritional counseling, increased physical activity, diabetic self-care skills, and behavioral strategies for weight management. Services can be provided in telemedicine, at home, or in clinics and outpatient settings.

To qualify for DSMES, an individual must be 18-64 years old and have a documented diagnosis based on specific criteria for type 1, type 2, or gestational diabetes. Participants must also receive a written referral from a qualified provider who is a physician, assistant doctor, nurse practitioner, or senior practicing nurse.

Participants are eligible for up to 18 hours of service in 12 months.

HFS and IDPH, with the support of federal partners CDC and the National Association of Chronic Disease Directors, are working with the Illinois Institute for Public Health to amend the Medicaid Plan to add coverage to these two programs. going.

Together, the DPP and DSMES programs are estimated to cost less than $ 1 million for the first year offered in Illinois. The state’s cost burden is estimated to be approximately $ 300,000 in the first year, with the rest covered by federal funding.

For services offered in the Service Pricing Settings, HFS requires an effective date of August 1st and may begin managing the Services with the approval of the Federal Center for Medicare & Medicaid Services.

Copyright 2021 WIFR. all rights reserved.