CMS Pub. 100-08, ch. 10, § 10.3.2.1

(See section 10.2.6 of this chapter for more information on Medicare Diabetes Prevention

Programs.)

A. Reason for Submittal

In this section, the supplier indicates the reason for submittal of the application. Unless

otherwise stated in this chapter, in another CMS directive, or as permitted by PECOS, the

supplier may only check one reason for submittal. For example, suppose a supplier is

changing its tax identification number (TIN). The supplier must submit two applications:

(1) an initial Form CMS-20134 as a new supplier; and (2) a Form CMS-20134 voluntary

termination. Both transactions cannot be reported on the same application.

Excluding (1) the voluntary termination checkbox and (2) the effective date of termination

data in the Basic Information section of the Form CMS-20134, any blank data/checkboxes

in the Basic Information section can be verified through any means the contractor chooses

(e.g., e-mail, telephone, the PCV, fax).

B. Centers for Disease Control (CDC) Diabetes Prevention Recognition Program

(DPRP)

To be eligible to enroll as an MDPP supplier, an entity must have either:

• MDPP preliminary recognition or

• DPRP full recognition

Note that MDPP preliminary recognition includes both interim preliminary recognition as

designated by CMS as well as preliminary DPRP recognition as designated by the CDC.

Organizations with preliminary or full CDC DPRP recognition must submit to CMS a copy

of its recognition letter provided by CDC. To verify the applicant’s eligibility, the

contractor shall:

• Verify that a letter has been submitted for each organizational code provided in

Sections 2 and 4 of the Form CMS-20134

• Verify that (1) any letters provided have appropriate letterhead from CDC and (2)

each reflects that the organization has met either preliminary or full recognition

with an expiration date that has not passed.

• Verify that the organization code or codes provided in Sections 2 and 4 of the Form

CMS-20134 matches both the organization code on the letter(s) and the

organization code on CDC’s online registry, which is updated just-in-time and can

be found at https://dprp.cdc.gov/cms/download.

• Verify that the CDC’s online registry or any list provided by CMS indicates that the

entity associated with that organization code is associated with either an in-person

or in-person with a distance learning component delivery mode and that a delivery

mode of in-person or in-person with a distance learning component is noted in the

letter’s letterhead.

• Verify that CDC’s online registry indicates that the entity associated with that

organization code has met either preliminary or full recognition.

• Verify that the name associated with the organization code on CDC’s online

registry is consistent with what is listed on the letter, as well as what is provided in

Sections 2 or 4 of the Form CMS-20134

Certificates or letters of the above recognitions are the only eligibility documents required

by Medicare to function as the supplier type in question. Any other licenses, certificates,

and permits that (1) are not of a medical nature or (2) are of a medical nature but unrelated

to MDPP are not required.

C. Recognition Status

In situations where an MDPP supplier is required to submit a copy of its CDC recognition

but fails to do so, the contractor need not obtain such documentation from the supplier if

the contractor can verify the information independently. This may be done by: (1)

reviewing and printing (or electronically saving in PECOS) confirming pages from the

Centers for Disease Control and Prevention Web site; (2) requesting and receiving from the

CDC written confirmation of the supplier’s status therewith; or (3) utilizing another third-party verification source. Similarly, if the supplier submits a copy of the applicable

recognition but fails to complete the applicable section of the form, the section need not be

completed if the data in question can be verified on the recognition itself or via any of the

three mechanisms described above in this paragraph. The contractor shall not develop for a

correction to the form if the recognition information can be verified as described above.

The above-referenced written confirmation of the supplier’s status can be in the form of a

letter, fax, or email, but it must be in writing. Documentation of a verbal conversation

between the contractor and the body in question does not qualify as appropriate

confirmation.