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Obesity Screening and Counseling Is New Medicare Benefit

December 6, 2011:

Karen M Adkins, Clinical/Technical Editor

On November 29, the Centers for Medicare and Medicaid Services (CMS) announced that it will cover preventive services aimed at reducing obesity. This new benefit will be available without any cost sharing, as with other Medicare preventive services under the Affordable Care Act.

More than 22 million Medicare beneficiaries received at least one free covered preventive service in 2011. The preventive services currently offered under the Medicare program complement a new joint initiative by CMS and the Centers for Disease Control and Prevention called the Million Hearts.

CMS Administrator Donald M. Berwick, MD, states that weight is a challenge Americans of all ages deal with and that “it’s important for Medicare patients to enjoy access to appropriate screening and preventive services.”

Medicare estimates that approximately 30 percent of beneficiaries are considered obese and that unhealthy weight can lead to a number of chronic conditions, including cardiovascular disease and diabetes. CMS believes that by addressing obesity now, it can reduce the number of heart attacks and strokes over the next five years and improve the health of Medicare beneficiaries.

Obesity screening and counseling for eligible beneficiaries will be offered by primary care providers in the office setting. Patients with a body mass index (BMI) of greater than or equal to 30 kg/m2 would receive one face-to-face visit for counseling each week for one month as well as a visit every other week for an additional five months. In addition, a beneficiary who has lost at least 6.6 pounds during his or her first six months of counseling is eligible to receive an additional six face-to-face visits over the course of a six-month period.

CMS’s chief medical officer and director of the agency’s Office of Clinical Standards and Quality summarized Medicare’s decision to offer this benefit by stating, “This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease. We at CMS are carefully and systematically reviewing the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible.”

For more information about the Million Hearts initiative, visit millionhearts.hhs.gov. For details on the national coverage determination, visit the CMS website here.


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