Medicare and coverage for Lifestyle counseling

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Centers for Medicare and Medicaid Services Decision Memo for Intensive

Behavioral Therapy for Obesity

The Centers for Medicare and Medicaid Services (CMS) has determined the

following:

The evidence is adequate to conclude that intensive behavioral therapy for

obesity, defined as a body mass index (BMI) ™ 30 kg/m2, 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 U.S. Preventive Services Task Force

(USPSTF).

Intensive behavioral therapy for obesity consists of the following:

1. 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);

2. Dietary (nutritional) assessment; and

3. Intensive behavioral counseling and behavioral therapy to promote sustained

weight loss through high intensity interventions on diet and exercise.

The intensive behavioral intervention for obesity should be consistent with the

5-A framework that has been highlighted by the USPSTF:

1. Assess: Ask about/assess behavioral health risk(s) and factors affecting

choice of behavior change goals/methods.

2. Advise: Give clear, specific, and personalized behavior change advice,

including information about personal health harms and benefits.

3. Agree: Collaboratively select appropriate treatment goals and methods based

on the patient's interest in and willingness to change the behavior.

4. Assist: Using behavior change techniques (self-help and/or counseling), aid

the patient in achieving agreed-upon goals by acquiring the skills, confidence,

and social/environmental supports for behavior change, supplemented with

adjunctive

medical treatments when appropriate.

5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide

ongoing assistance/support and to adjust the treatment plan as needed, including

referral to more intensive or specialized treatment.

For Medicare beneficiaries with obesity, who are 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, CMS

covers:

* 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 meets

the 3kg weight loss requirement as discussed below.

At the six month visit, a reassessment of obesity and a determination of the

amount of weight loss must be performed. To be eligible for additional

face-to-face visits occurring once a month for an additional six months,

beneficiaries must have

achieved a reduction in weight of at least 3kg over the course of the first six

months of intensive therapy. This determination must be documented in the

physician office records for applicable beneficiaries consistent with usual

practice. For beneficiaries who do not achieve a weight loss of at least 3kg

during the first six months of intensive therapy, a reassessment of their

readiness to change and BMI is appropriate after an additional six month period.

Link to full decision document:

http://library.constantcontact.com/download/get/file/1011051281441-493/CMS_cover\

age_of_obesity_treatment_sans_cover.pdf

S. Kalman PhD, RD, FACN

Director, BD - Nutrition & Applied Clinical Trials

Miami Research Associates

6141 Sunset Drive

Suite 301

Miami, FL. 33143

Direct -

Office ext. 5109

Fax

Email: dkalman@...

Web: www.miamiresearch.com<www.mraclinicalresearch.com/>

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