The Medicare Obesity Counseling Benefit
Preventive measure offer weekly help
The Centers for Disease Control and Prevention reports that obesity rates in the U.S. have increased dramatically over the last 30 years, and obesity is now an epidemic in our nation. In the Medicare population, over 30 percent of men and women are obese. Obesity is directly or indirectly associated with many chronic diseases, not the least of which is diabetes, high blood pressure, high blood cholesterol, cardiovascular disease, arthritis, and a host of other ailments.
The really good news for all Medicare beneficiaries with Part B insurance is that Medicare now pays for obesity counseling to help enrollees fight the battle of the bulge! The name of the Medicare obesity benefit is "Intensive Behavior Therapy for Obesity" and it is fully paid by Medicare with no patient copayment. It is called ‘intensive' for a number of reasons:
• Medicare pays for 22 visits in the first continuous 12 months for beneficiaries with a body mass index (BMI) of 30 or more.
• The beneficiary can receive weekly in-person intensive behavioral therapy visits for the first month, followed by visits every two weeks for an additional five months.
• Additional one-time-per-month sessions will be covered in months 7 through 12 if the beneficiary has lost at least 6.6 pounds during the first six months of the therapy.
• The registered dietitian, nutritionist, or other qualified healthcare professional with expertise in weight management has to adhere to a set of very specific counseling guidelines so that the beneficiary receives the very best weight loss therapy.
• The 22 visits can be repeated every year after the first, as long as the beneficiary has a BMI of 30 or more and the treating provider orders the benefit.
If the beneficiary does not lose the 6.6 pounds in the first six months, he/she may be re-evaluated after the initial year. Those showing "readiness to change" and a BMI of 30 or more may receive another round of counseling.
You also noticed two other key words in the name…. ‘behavior therapy.' This sounds so very clinical! What this behavior therapy actually consists of is summarized in what Medicare calls the "5 A's:" the A's act as the set of evidence-based steps that the counselor takes with the beneficiary:
Assess: Ask about/assess behavioral health risk(s) and factors affecting the choice of behavior change goals/methods.
Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
Agree: Collaboratively select appropriate treatment goals and methods based on the patient's interest in and willingness to change the behavior.
Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with added medical treatments when appropriate.
Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed.
You can read more about this new preventive Medicare benefit at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/ICN907800.pdf
Also, please do not be shy about asking your healthcare provider about the Medicare obesity counseling benefit, especially if you have diabetes or prediabetes. Remember that even a very small amount of excess weight that is lost can significantly help get and keep blood sugar values in the target range.
Mary Ann is a consultant, speaker, writer and trainer for the health, food and pharmaceutical industries in nutrition, diabetes and insurance reimbursement. Her clients include healthcare entities, membership associations, research firms, pharmacies, education/training firms, government, websites, academia, media and individual healthcare professionals. Mary Ann specializes in helping clients establish AADE-accredited DSME programs, MNT programs, shared medical appointments, marketing and insurance reimbursement policies and procedures, and training educators on motivational interviewing and strategies for successful patient behavior change. Mary Ann is on the AADE Board of Directors and has served on numerous committees of the Academy of Nutrition and Dietetics, its practice groups and state affiliates.
For more information about Mary Ann Hodorowicz, RD, MBA, CDE, CEC and Mary Ann Hodorowicz Consulting, LLC, visit www.maryannhodorowicz.com - Nutrition, Diabetes Care & Education, Health Promotion and Insurance Reimbursement for Professionals for the Healthcare and Food Industry.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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