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Medicare Decides Obesity
is Health Danger They Will Pay to Correct
July 15, 2004 – A new Medicare
coverage policy was announced today that will remove barriers to
covering anti-obesity interventions, “if scientific and medical evidence
demonstrate their effectiveness in improving Medicare beneficiaries'
health outcomes.”
HHS Secretary Tommy G. Thompson
today announced a new Medicare coverage policy that would remove
barriers to covering anti-obesity interventions
"Obesity is a critical public
health problem in our country that causes millions of Americans to
suffer unnecessary health problems and to die prematurely. Treating
obesity-related illnesses and complications adds billions of dollars to
the nation's health care costs," HHS Secretary Tommy G. Thompson said
during testimony before the Senate Appropriations Subcommittee on Labor,
Health and Human Services and Education. "With this new policy, Medicare
will be able to review scientific evidence in order to determine which
interventions improve health outcomes for seniors and disabled Americans
who are obese and its many associated medical conditions."
Today's new policy from HHS'
Centers for Medicare & Medicaid Services (CMS) removes language in the
Medicare Coverage Issues Manual stating that obesity is not an illness.
This step allows members of the public to request that Medicare review
medical evidence to determine whether specific treatments related to
obesity would be covered by Medicare.
By law, Medicare covers
specified medically necessary services for illness and injury. The prior
manual language, because it stated that obesity was not an illness,
could prevent Medicare from covering treatments for diseases related to
obesity.
"From the standpoint of Medicare
coverage and the health of our beneficiaries, the question isn't whether
obesity is a disease or a risk factor. What matters is whether there's
scientific evidence that an obesity-related medical treatment improves
health," said CMS Administrator Mark McClellan, M.D., Ph.D. "This change
in Medicare's coverage policy puts the focus on public health. The
medical science will now determine whether we provide coverage for the
treatments that reduce complications and improve quality of life for the
millions of Medicare beneficiaries who are obese."
The new policy is not expected
to have an immediate impact on Medicare coverage. It does not affect the
existing Medicare coverage of treatments of diseases resulting in or
made worse by obesity, in particular currently covered surgical
treatments for morbidly obese individuals.
However, as requests for
coverage of obesity treatments are made by the public, Medicare will
implement timely review of the scientific evidence, using the coverage
determination procedures established in 1999 and modified by the
Medicare Modernization Act of 2003. Detailed information on this process
can be found on the Medicare coverage Web site
http://www.cms.gov/coverage. Essential to this process is the
submission of published, clinical trial data that demonstrate that
obesity-related treatments improve the health of Medicare beneficiaries.
"We encourage and we're
expecting requests to review scientific evidence evaluating the benefits
of a range of treatments for obesity in the Medicare population," said
CMS Chief Medical Officer Sean Tunis, M.D. "As a first step, we expect
to convene our Medicare Coverage Advisory Committee in the fall to
evaluate the evidence on obesity-related surgical procedures that may
reduce the risk of heart disease and other illnesses."
More information about today's
decision can be found at
http://www.cms.hhs.gov/ncdr/searchdisplay.asp?id=57 |
