Fw: Petition Response: Treating Obesity Through Total Health Care

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Sigh.

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Holly Lee Brewer, MS RD

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

      ----- Forwarded Message -----

To: hlbrewer@...

Sent: Tuesday, March 27, 2012 4:52 PM

Subject: Petition Response: Treating Obesity Through Total Health Care

Petition Response: Treating Obesity Through Total Health Care

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>   

>Treating Obesity Through Total Health Care

>By Blum, Deputy Administrator and Director for the Center of Medicare,

Centers for Medicare and Medicaid Services

>Thank you for your interest in helping Americans become and stay healthy

through healthy eating. I am writing to respond to yourpetition asking CMS to

reconsider its decision excluding Registered Dietitians from direct billing for

Obesity Therapy.

>Obesity is a serious problem in this country and worldwide. The Centers for

Disease Control and Prevention (CDC) has reported that " obesity rates in the

U.S. have increased dramatically over the last 30 years, and obesity is now

epidemic in the United States " (Kahn, 2009). According to a 2010 study of health

and nutrition, for adults 60 years and older, obesity exists in about 37% of men

and 34% of women.

>The Centers for Medicare & Medicaid Services (CMS) released a National Coverage

Determination (NCD) on November 29, 2011 addressing intensive behavioral therapy

for obesity in Medicare beneficiaries with a body mass index (BMI) of 30 kg/m2

or greater. The final decision memorandum states that coverage is limited to the

primary care setting.

>In response to public comments on the NCD urging that coverage be extended to

services furnished by other types of practitioners including registered

dieticians, CMS explained:

>[W]e believe it is important that these preventive services should be furnished

in a coordinated approach as part of a comprehensive prevention plan within the

context of the patient's total health care. Primary care practitioners are

characterized by their coordination of a patient's comprehensive healthcare

needs. ... Other provider specialties may provide patient care in other settings

but do not offer care in the context of being the coordinator of the patient's

healthcare needs, not limited by problem origin or diagnosis. Coordination of

health services is especially important in the presence of the coexisting health

issues of our Medicare beneficiaries.

>We understand that registered dieticians would like to provide and bill

Medicare directly for intensive behavioral therapy for obesity. The decision

memorandum provides background and explanation for the NCD including that

Medicare coverage is modeled on the evidence-based recommendations of the United

States Preventive Services Task Force (USPSTF). The USPSTF evidence review on

treatment for obesity (on which their dietary counseling recommendation is

based) is available in the petition response.

>In the public comment section of the decision memorandum, we further responded

to comments requesting coverage for these services when furnished by non-primary

care practitioners with the following language:

>In the primary care office setting, Medicare may cover these services when

billed by the primary care physician or practitioner and furnished by auxiliary

personnel under the conditions specified under our regulation at 42 CFR section

410.26( (conditions for services and supplies incident to a physician's

professional service).

>As this language indicates, other " auxiliary personnel, " which may include

registered dietitians, are able to furnish intensive behavioral therapy for

obesity services when provided in the primary care setting under the rules and

conditions of existing Medicare regulations. The primary care physician or

practitioner would need to submit the claim for billing.

>We support the work of registered dietitians and recognize their valuable

contribution to our society. We will continue to collaborate with all clinicians

and groups who want to help us combat the obesity epidemic in our Nation, and

continue to consider this policy in the future.

>Check out this response on We the People.

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