HHS To Allow Expanded Medicare Coverage for Obesity Treatments
HHS Secretary Tommy Thompson on Thursday plans to announce at a Senate hearing that the department will remove language from the Medicare manual that states obesity is not an illness but will not classify the condition as a disease, the Wall Street Journal reports. The move will allow for expanded Medicare coverage of obesity treatments; under current policy, the program only covers obesity treatments when beneficiaries also have related conditions such as diabetes. However, because HHS will not classify obesity as a disease, Medicare will not have to cover "medically necessary interventions," according to the Journal. Under the new policy, Medicare will make no immediate coverage changes because obesity treatments "first must be shown to improve health," the Journal reports. "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," Thompson said. CMS Administrator Mark McClellan said, "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." Under the new policy, Medicare could begin to cover obesity treatments such as gastric bypass surgery and diet counseling but not weight-loss medications; the new Medicare law bars coverage for such treatments.
The new policy, which CDC requested in 2001 to help address the obesity issue in the United States, "will disappoint advocates for people with obesity who had pressed" for HHS to classify obesity as a disease, according to the Journal. Business groups have opposed expanded Medicare coverage for obesity treatments because "coverage for expensive weight-loss surgery would increase pressure for private insurers and employers to expand coverage as well," the Journal reports (Lueck, Wall Street Journal, 7/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.