Re: Fw: CMS's Final Decision on Intensive Behavioral Counseling for Obesity

[Guest guest]

Yes, you did. You might have missed my sarcasm about my feelings towards

ADA.

> **

>

>

> Jen,

>

> How should ADA market your services for you? Which PCPs would you like ADA

> to contact to let them know what you can do for them?

>

> I'm sure I misunderstood your meaning behind that statement.

>

> Regards,

> pam

>

> Pam Charney, PhD, RD

> Author, Consultant

> pcharney@...

>

> " If all you ever do is all you've ever done, than all you'll ever get is

> all you ever got " - Anonymous

>

>

>

>

> > I love how they put it back on us. Continue to market yourself and your

> > services to primary care providers.

> >

> >

> >

> >> **

>

> >>

> >>

> >> FYI

> >>

> >> ----------

> >> Holly Lee Brewer, MS RD CDE

> >> Pediatric Dietitian, Diabetes Educator

> >> Medical Nutrition Therapist, Las Vegas, NV

> >>

> >> Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

> >> 301st MDS, NAS JRB Fort Worth (Carswell), TX

> >> Joint Base Balad, Iraq (Jan-Jul 2009)

> >>

> >> ----- Forwarded Message -----

> >>>

> >>> To: hlbrewer@...

> >>> Sent: Wednesday, December 7, 2011 1:20 PM

> >>> Subject: CMS's Final Decision on Intensive Behavioral Counseling for

> >> Obesity

> >>>

> >>>

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> >>>

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> >>>

> >>>

> >>> CMS's Final Decision on Intensive Behavioral Counseling for Obesity and

> >> How it Affects RD's

> >>> Dear Holly,

> >>>

> >>>

> >>>

> >>> The American Dietetic Association understands and shares members'

> >> concerns about the announcement by the Centers for Medicare & Medicaid

> >> Services (CMS) on Tuesday, November 29 about their decision to cover

> >> Intensive Behavioral Counseling for Obesity for eligible Medicare

> >> beneficiaries. We'd like to share the following information in an

> effort to

> >> answer member questions about this decision and what it means for

> >> Registered Dietitians (RDs).

> >>>

> >>> How did CMS make this decision?

> >>>

> >>> Through the Medicare Improvements for Patients and Providers Act

> (MIPPA),

> >> CMS has the authority to add coverage of additional preventive services

> >> under a process called a National Coverage Determination. This process

> is

> >> not a legislative one, meaning the decision is not made through

> Congress.

> >> Rather, CMS is the decision-making body. CMS is required to evaluate

> >> relevant clinical evidence to determine whether or not the proposed

> service

> >> meets three criteria:

> >>> 1. Reasonable and necessary for the prevention or early detection of

> >> illness or disability;

> >>> 2. Is recommended with a Grade A or B by the US Preventive Services

> Task

> >> Force; and

> >>> 3. Is appropriate for individuals entitled to benefits under Part A or

> >> enrolled under Part B of the Medicare program.

> >>>

> >>> The process includes two opportunities for public comment. On March 11,

> >> 2011 CMS announced it was opening a national coverage analysis for

> >> Intensive Behavioral Therapy for Obesity with a 30-day public comment

> >> period. On August 31, 2011 CMS issued its proposed decision memorandum

> with

> >> a 30-day comment period.

> >>>

> >>> Was ADA involved?

> >>>

> >>> Definitely! ADA offered comments during both public comment periods.

> >> These comments incorporated input from members with expertise in weight

> >> management services and were reviewed and approved by member leaders.

> Visit

> >> http://www.eatright.org/mnt/ and scroll down to " Medicare MNT Coverage

> >> Expansion " to read more. In November ADA also met with CMS staff, along

> >> with other members of the Obesity Care Coalition, to advocate for

> inclusion

> >> of RDs in the proposed benefit.

> >>>

> >>> What exactly did CMS decide to cover?

> >>>

> >>> CMS determined it will cover screening and intensive behavioral

> >> counseling for obesity by primary care providers in settings such as

> >> physicians' offices for Medicare beneficiaries with a body mass index

> (BMI)

> >>> 30 kg/m2. Specifically, Medicare will 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

> >> has achieved a reduction in weight of at least 3kg over the course of

> the

> >> first six months of intensive therapy.

> >>>

> >>> The service must be furnished by a " qualified primary care physician or

> >> other primary care practitioner and in a primary care setting. " CMS

> refers

> >> to the Social Security Act for its definition of a " qualified primary

> care

> >> physician " to mean a physician who is a general practitioner, family

> >> practice practitioner, general internist or obstetrician or

> gynecologist.

> >> In similar manner, CMS defines " primary care practitioner " as a

> physician

> >> with a primary specialty designation of family medicine, internal

> medicine,

> >> geriatric medicine or pediatric medicine or a nurse practitioner,

> clinical

> >> nurse specialist, or physician assistant in accordance with the Social

> >> Security Act.

> >>>

> >>> Lastly, the service must be furnished in the primary care setting. CMS

> >> defines a primary care setting " as one in which there is provision of

> >> integrated, accessible health care services by clinicians who are

> >> accountable for addressing a large majority of personal health care

> needs,

> >> developing a sustained partnership with patients, and practicing in the

> >> context of family and community. Emergency departments, inpatient

> hospital

> >> settings, ambulatory surgical centers, independent diagnostic testing

> >> facilities, skilled nursing facilities, inpatient rehabilitation

> facilities

> >> and hospices are not considered primary care settings under this

> >> definition. "

> >>>

> >>> What was the rationale behind CMS's decision to not include RDs as

> >> providers of these services?

> >>>

> >>> Based on CMS's responses to public comments in this final decision memo

> >> as well as the one issued earlier this month for Intensive Behavioral

> >> Counseling for Cardiovascular Disease, it appears that CMS excluded RDs

> for

> >> two reasons:

> >>> 1. CMS believes it lacks the statutory authority to include RDs as

> >> providers outside of diabetes and end stage renal disease; and

> >>> 2. CMS believes it is important that preventive services be furnished

> in

> >> a coordinated approach as part of a comprehensive prevention plan within

> >> the context of the patient's total health care. As such, they believe

> >> primary care practitioners are best qualified to offer care in this

> context.

> >>>

> >>> How will these services be paid and when does the benefit become

> >> effective?

> >>>

> >>> The answers to these questions have yet to be determined. CMS is in the

> >> process of establishing codes and developing the claims processing

> >> instructions for this NCD.

> >>>

> >>> What do we do now?

> >>>

> >>> As individual practitioners:

> >>> RDs as providers of nutrition services have 2 options when it comes to

> >> obesity services for Part B Medicare beneficiaries:

> >>> 1. The CMS decision memorandum does state that the new benefit does not

> >> preclude primary care practitioners from referring eligible

> beneficiaries

> >> to other practitioners and/or settings for counseling; however coverage

> >> remains only in the primary care setting. So RDs can receive referrals

> >> for these services, but the Medicare beneficiary would need to be

> informed

> >> prior to providing the service that it is not covered by Medicare and

> they

> >> would be required to pay out of pocket for the service.

> >>> 2. The CMS decision memorandum also states that in the primary care

> >> office setting and primary care hospital outpatient setting, Medicare

> may

> >> cover these services when furnished by auxiliary personnel (e.g., RDs)

> and

> >> billed as " incident to " services in accordance with 42 CFR section

> >> 410.26( or 410.27, meaning:

> >>> 1. There is direct physician supervision of auxiliary personnel (the

> >> physician must be present in the office suite and immediately available

> to

> >> provide assistance and direction throughout the time the service is

> being

> >> provided).

> >>> 2. " Auxiliary personnel " means any individual who is acting under the

> >> supervision of a physician, regardless of whether the individual is an

> >> employee, leased employee, or independent contractor of the physician,

> or

> >> of the legal entity that employs or contracts with the physician.

> >>> Note: Medicare Part B MNT services for diabetes and non-dialysis renal

> >> disease cannot be billed as " incident to " services since they are

> >> recognized as a separate benefit category.

> >>>

> >>> We recognize that both of these options fall short of the ideal

> scenario.

> >> However, as healthcare delivery and payment models move away from

> >> fee-for-service to bundled payment models (such as Patient-Centered

> Medical

> >> Homes and Accountable Care Organizations), now is a good time for RDs to

> >> align themselves with primary care practitioners in new ways. Continue

> to

> >> market yourself and your services to both primary care practitioners and

> >> Medicare beneficiaries to create demand for your services and

> demonstrate

> >> the value you bring to a comprehensive and coordinated model of care.

> As an

> >> RD, you can positively impact a practice's bottom line by helping

> patients

> >> and the practice achieve positive clinical outcomes. Most importantly,

> you

> >> can collect, report, and publish outcomes data to strengthen the

> foundation

> >> of clinical evidence used by CMS and others in making coverage

> decisions.

> >>>

> >>> As ADA:

> >>>

> >>> The Nutrition Services Coverage team and the Policy Initiatives and

> >> Advocacy team are strategically working to position RDs as providers of

> MNT

> >> in other disease conditions through a variety of initiatives. With this

> >> new insight into CMS's approach to expanding coverage, we are exploring

> >> potential strategies on both the legislative and regulatory fronts. We

> will

> >> continue to share information with members through all available

> >> communication channels.

> >>>

> >>> Click here to read the full CMS Final Decision Memorandum.

> >>>

> >>> Nutrition Services Coverage Team

> >>> Reimburse@...

> >>>

> >>>

> >>> Nevada Dietetic Association

> >>> www.NevadaRD.com

> >>> NevadaRD@...

> >>>

> >>>

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> >>>

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