The Access to Care Committee chaired by Dr. John Morton has continued its efforts to provide coverage for care of the obese patient particularly to have CMS fully cover sleeve gastrectomy. On October 1, 2012, CMS removed the non-coverage designation for sleeve gastrectomy clearing the way for local Medicare Regional Administrators to cover the procedure. To date, all local Medicare Regional Administrators are on a path to provide coverage. A few regional administrators have indicated they will only cover for age <60. ASMBS is responding to this age exclusion with previously published papers and latest data from BOLD and UHC. Full coverage will take 2-3 months as regional administrators add coverage. Check with local administrators prior to performing cases- local administrators are listed in our previous CMS sleeve FAQs.
Both Dr. Wayne English and Dr. Teresa LaMasters represented the ASMBS Access committee at local CMS administrator hearings in Chicago and Omaha. Dr. Mitch Roslin and Dr. Ashton Kaul presented in New York City for CMS regional administrators.
Secondly, this September, Access to Care has also sent letters supporting Essential Health Benefit coverage for obesity care to the benefit planning offices for the states of Connecticut, Illinois, South Carolina, Washington and District of Columbia.
Finally, Dr. Robert Lim (US Army) has successfully advocated that TRICARE change their approval for bariatric care to follow the NIH criteria and not 100 lbs overweight condition.