C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-71, app Appendix
As set forth in Section 71.03-2(A), member eligibility for services under this section is based, in part, on the member meeting the participant eligibility requirements in the DPRP Standards. As of the legal effective date of this rule, the following are the DPRP's participant eligibility requirements:
A. All of a program's participants must be 18 years of age or older. The program is intended for adults at high risk of developing type 2 diabetes.
B. All of a program's participants must have a body mass index (BMI) of [GREATOR THAN OR EQUAL TO] 25 kg/m2 ([GREATOR THAN OR EQUAL TO] 23 kg/m2, if Asian American).
C. All of a program's participants must be considered eligible based on either:
1. A blood test result within one year of participant enrollment. Blood test results may be self-reported for CDC recognition purposes. Participants enrolled in the Medicare Diabetes Prevention Program (MDPP) cannot self-report blood test results; lab results must be provided. Blood test results must meet one of the following specifications:
a. Fasting glucose of 100 to 125 mg/dl (Centers for Medicare and Medicaid Services (CMS) eligibility requirement for MDPP participants is 110 to 125 mg/dl);
b. Plasma glucose of 140 to 199 mg/dl measured 2 hours after a 75 gm glucose load;
c. HbA1c of 5.7 to 6.4; or
d. Clinically diagnosed gestational diabetes mellitus (GDM) during a previous pregnancy (allowed for CDC recognition and may be self-reported; not allowed for MDPP participants); or
2. A positive screening for prediabetes based on the Prediabetes Risk Test online at: https://www.cdc.gov/prediabetes/takethetest/. Note: The risk test is not an option for eligibility for MDPP participants.
D. Participants cannot have a previous diagnosis of type 1 or type 2 diabetes prior to enrollment.
E. Participants cannot be pregnant at time of enrollment.
F. A health care professional may refer potential participants to the program, but a referral is not required for participation in a CDC-recognized program.*
Recognized organizations can retain participants if either of the following situations occur:
A. Participants develop type 2 diabetes while in the program. These participants should be referred to their primary care providers for referrals to American Diabetes Association (ADA)-recognized or Association of Diabetes Care and Education Specialists (ADCES)- accredited diabetes self-management education and support (DSMES) services and other resources such as Medical Nutrition Therapy (MNT) as appropriate. See Submitting Evaluation Data to the DPRP section for details on how to code these participants to ensure they are not considered eligible in the evaluation.
B. Participants become pregnant while in the program. The National DPP LCP emphasizes weight loss and is not appropriate for women who are currently pregnant. Participants who become pregnant may continue at the discretion of their health care providers and the CDC-recognized organization. See Submitting Evaluation Data to the DPRP section for details on how to code these participants to ensure they are not considered eligible in the evaluation.
*Pursuant to Section 71.03-2(B), MaineCare requires a referral from a physician or other qualified provider acting within his or her scope of practice for a member to participate in the National DPP LCP.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-71, app Appendix