CMS proposes coverage of intensive behavioral therapy for obese seniors

The CMS has issued a decision memorandum proposing coverage of intensive behavioral therapy for seniors with a BMI of more than 30.

According to the CMS, intensive behavioral therapy for obesity consists of the following:

Screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (expressed in kg/m²);
Dietary assessment; and
Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high-intensity interventions on diet and exercise.

For obese Medicare beneficiaries who are deemed 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 and in a primary care setting, the CMS proposes coverage of:

One face-to-face visit every week for the first month;
One face-to-face visit every other week for months 2 to 6; and
One face-to-face visit every month for months 7 to 12.

At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss should be performed. To be eligible for face-to-face visits occurring once a month for an additional 6 months, beneficiaries must have achieved a reduction in weight of at least 3 kg during the course of the first 6 months of intensive therapy. This determination must be documented in the physician office records for applicable beneficiaries consistent with usual practice, according to the memo posted on the CMS website.

The CMS is authorized to add new preventive services if it is determined to be 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 by the United States Preventive Services Task Force (USPSTF).

The CMS is requesting public comments on this proposed determination pursuant to Section 1862(I) of the Social Security Act. After considering the public comments, the CMS will make a final determination and issue a final decision memorandum.

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