Departments of Health in Maryland and Oregon are implementing a two-year project to demonstrate methods for offering the DPP to the Medicaid population through Managed Care Organizations (MCOs) and Accountable Care Organizations (ACOs). Year 1 progress includes:
Maryland Medicaid contracted with four of their managed care organizations (MCOs) and Oregon contracted with three of their Coordinated Care Organizations (CCOs) to offer the DPP to 100 eligible participants per MCO or CCO, for a total reach of 700 Medicaid beneficiaries. Maryland began enrolling eligible Medicaid beneficiaries in the program in January and Oregon plans to start enrolling in February 2017.
Maryland created a billing and coding procedure document that includes ICD-10 codes to assign eligibility for the DPP. This procedure will be used by their MCOs and DPP delivery sites to operationalize Medicaid reimbursement for the program in Maryland. It has the potential to serve as a model for other health plans interested in covering the DPP.
As part of this project, NACDD plans to release an online National DPP Coverage Toolkit to serve as a resource for commercial health plan coverage of the DPP and for state efforts to explore, move forward and sustain Medicaid coverage for the program. The toolkit will provide answers to questions payers have about covering the program so that payers can make an informed decision. Examples of these questions include how to determine eligibility, how to code and bill, how to represent the services the program offers in contract language with managed care and state plan amendments with CMS, and how to calculate the medical loss ratio. The toolkit will be available in June 2017. For more information contact Kelly McCracken at firstname.lastname@example.org.