Medicare to Consider Obesity Coverage

Washington

After a three-year investigation, HHS has removed language stating obesity is not an illness from Medicare’s Coverage Issues Manual, paving the way for possible coverage of obesity treatment.

In 2001, the Centers for Disease Control and Prevention asked CMS to review the issue of whether obesity should be considered an illness, but until now, the agency has denied coverage for obesity therapies. While the language change still does not define obesity as a disease, the revision does allow beneficiaries to request coverage for obesity-related treatments. “The critical issue is not the classification of obesity but whether particular items or services are reasonable and necessary,” according to CMS.

“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,” said Health and Human Services Secretary Tommy Thompson.

At this point, what exact treatments Medicare will cover remains unclear. As beneficiaries request coverage, Medicare will implement review on a case-by-case basis using current coverage determination procedures, according to HHS.

“We believe there is a significant population that could benefit from various mobility and ambulatory products that, prior to this decision, did not have access to the medical devices because of funding issues,” commented Steven Cotter, president of bariatric manufacturer Gendron, Archbold, Ohio.

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