For Medicare beneficiaries with obesity, who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting, Centers for Medicare & Medicaid Services (CMS) will now cover:
- One face-to-face visit every week for the first month;
- One face-to-face visit every other week for months 2-6;
- One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement as discussed below.
At the six month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed. To be eligible for additional face-to-face visits occurring once a month for an additional six months, beneficiaries must have achieved a reduction in weight of at least 3kg over the course of the first six months of intensive therapy. This determination must be documented in the physician office records for applicable beneficiaries consistent with usual practice. For beneficiaries who do not achieve a weight loss of at least 3kg during the first six months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional six month period.
For the purposes of this decision memorandum a “primary care physician” and “primary care practitioner” will be defined consistent with existing sections of the Social Security Act (§1833(u)(6), §1833(x)(2)(A)(i)(I) and §1833(x)(2)(A)(i)(II)).
§1833(u)
While this is a HUGE step in the right direction of putting a stop towards the rising rate of obesity it is sad to see that Registered and Licensed Dietitians, who are uniquely qualified to effectively address weight management at low cost.
For more information on this newly developed benefit visit:
More information about this major Medicare policy revision can be found at http://www.eatrightwashington.org/docs/Reimbursement/Medicare%20Coverage%20for%20Obesity%20Counseling%20Nov%202011.pdf
Sincerely,
Ron H. Graham RD, LD, MPH
