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Medicare to cover screening, counseling for obesity
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The CMS recently announced that it will now offer coverage for preventive services to reduce obesity, according to a press release.
“Obesity is a challenge faced by Americans of all ages, and prevention is crucial for the management and elimination of obesity in our country,” CMS administrator Donald M. Berwick, MD, said in the release. “It’s important for Medicare patients to enjoy access to appropriate screening and preventive services.”
In its final decision memo, the CMS stated: “The evidence is adequate to conclude that intensive behavioral therapy for obesity is reasonable and necessary for the prevention or early detection of illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B and is recommended with a grade of A or B by the US Preventive Services Task Force (USPSTF).”
Also in the memo, the CMS said intensive behavioral therapy includes screening for obesity in adults using BMI; dietary assessment; and intensive behavioral counseling and therapy to promote sustained weight loss through high-intensity diet and exercise interventions.
Additionally, the CMS said intensive behavioral interventions should be consistent with the USPSTF’s 5-A framework:
- Assess: Ask about or assess behavioral health risks and factors affecting choice of behavior change goals or methods.
- Advise: Give clear, specific and personalized behavior change advice, including information about personal health harms and benefits.
- Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
- Assist: Using behavior change techniques, aid the patient in achieving agreed-upon goals by acquiring skills, confidence and social or environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
- Arrange: Schedule follow-up contacts, either in person or by telephone, to provide ongoing assistance or support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.
Under the new initiative, eligible beneficiaries who screen positive for obesity, defined as a BMI of at least 30, would receive coverage for one face-to-face counseling visit per week for 1 month and one face-to-face counseling visit every other week for an additional 5 months. Further, if eligible beneficiaries achieve a weight loss of at least 6.6 lb during the first 6 months of counseling, they are available for an additional 6 months of counseling.
“This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease,” said Patrick Conway, MD, MSc, CMS chief medical officer and director of the agency’s Office of Clinical Standards and Quality. “We at CMS are carefully and systematically reviewing the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible.”
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