HHS Announces Revised Medicare Obesity Coverage Policy

HHS Secretary Tommy G. Thompson today announced a new Medicare coverage
policy that would remove barriers to covering anti-obesity interventions if
scientific and medical evidence demonstrate their effectiveness in improving
Medicare beneficiaries' health outcomes.

"Obesity is a critical public health problem in our country that causes
millions of Americans to suffer unnecessary health problems and to die
prematurely.  Treating obesity-related illnesses and complications adds
billions of dollars to the nation's health care costs," Secretary Thompson
said during testimony before the Senate Appropriations Subcommittee on
Labor, Health and Human Services and Education.  "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."

Today's new policy from HHS' Centers for Medicare & Medicaid Services (CMS)
removes language in the Medicare Coverage Issues Manual stating that obesity
is not an illness.  This step allows members of the public to request that
Medicare review medical evidence to determine whether specific treatments
related to obesity would be covered by Medicare.

By law, Medicare covers specified medically necessary services for illness
and injury.  The prior manual language, because it stated that obesity was
not an illness, could prevent Medicare from covering treatments for diseases
related to obesity.

"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," said CMS Administrator
Mark McClellan, M.D., Ph.D.  "This change in Medicare's coverage policy puts
the focus on public health. The medical science will now determine whether
we provide coverage for the treatments that reduce complications and improve
quality of life for the millions of Medicare beneficiaries who are obese."

The new policy is not expected to have an immediate impact on Medicare
coverage.  It does not affect the existing Medicare coverage of treatments
of diseases resulting in or made worse by obesity, in particular currently
covered surgical treatments for morbidly obese individuals.

However, as requests for coverage of obesity treatments are made by the
public, Medicare will implement timely review of the scientific evidence,
using the coverage determination procedures established in 1999 and modified
by the Medicare Modernization Act of 2003.  Detailed information on this
process can be found on the Medicare coverage Web site www.cms.gov/coverage.
Essential to this process is the submission of published, clinical trial
data that demonstrate that obesity-related treatments improve the health of
Medicare beneficiaries.

"We encourage and we're expecting requests to review scientific evidence
evaluating the benefits of a range of treatments for obesity in the Medicare
population," said CMS Chief Medical Officer Sean Tunis, M.D.  "As a first
step, we expect to convene our Medicare Coverage Advisory Committee in the
fall to evaluate the evidence on obesity-related surgical procedures that
may reduce the risk of heart disease and other illnesses."

More information about today's decision can be found at
http://www.cms.hhs.gov/ncdr/searchdisplay.asp?id=57