Obesity Counseling to Be Covered by Medicare

The Centers for Medicare and Medicaid Services announced yesterday that Medicare insurance will pay for obesity screening, nutritional assessment and counseling, a preventive service made possible through the Affordable Care Act.

Million Hearts

With the numbers of obese people being at an all-time high in the United States, the availability of paid services to address the problem is expected to prevent at least one million strokes and heart attacks in the next five years, according to CMS.

The coverage of obesity screening and counseling, along with a nutritional assessment, with no cost sharing by Medicare recipients complements the efforts of the Million Hearts initiative that includes The Centers for Disease Control and Prevention, other Department of Health and Human Services programs and the private sector. Because obesity is one of the leading causes of cardiovascular disease and stroke, along with other chronic diseases such as diabetes and hypertension, it follows that treatment for obesity in the form of counseling would become one more prong in this multi-pronged approach to prevent heart attacks and stroke.

Medicare Screening and Counseling Coverage for Obesity

Medicare recipients whose body mass index is equal to or greater than 30 kg/2m will be eligible for these newly paid services. Screening to determine your BMI will be paid through Medicare, as well as the follow-up counseling appointments.

The recipients eligible for services will be entitled to receive a no-cost nutritional assessment.

Counseling structure for the paid services include weekly visits for the first month, then every two weeks for the next five months. If, during this six month period, the individual has lost at least 6.6 pounds, they are eligible to receive once monthly counseling for an additional six months — meaning 12 months of service.

Medicare will pay for these services only if they are provided through a primary care provider. Counseling provided in group facilities such as long term care or skilled nursing units for obesity will not be covered, nor will services through a mental health provider, as explained in CMS’ press release.

Preventive Services

CMS reports that more than 22 million people with original Medicare used one or more of the already existing preventive services in place through October this year. The Decision Memo for Intensive Behavioral Therapy for Obesity by CMS explains that evidence is adequate to show that payment for the obesity screening and counseling services is warranted as a prevention or early detection of illness or injury for people who are obese.

The U.S. Preventive Services Task Force studied the evidence behind the rationale for these preventive services and gave its recommendation for them.

Sources: Centers for Medicare and Medicaid Services; Press Release; Medicare Covers Screening and Counseling for Obesity; November 29, 2011.
Million Hearts; About the Campaign
Centers for Medicare and Medicaid Services; Decision Memo for Intensive Behavioral Therapy for Obesity; November 29, 2011

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