Dr. John Morton, ASMBS Secretary-Treasurer and Access Chair, provided an update on ASMBS Advocacy efforts at the ASMBS Fall Event Town Hall in Las Vegas.
First, the CMS sleeve gastrectomy approval process continues with CMS removing the Non-Coverage Designation for Sleeve Gastrectomy as of Oct 1, 2012. The local regional administrators will require time to implement the sleeve coverage decision and may impose specific age and pre-op weight loss requirements. ASMBS Access is working to remove all restrictions before the implementation due dates (1/31/13 for most administrators) for the CMS regional administrators. For the latest update regarding CMS regional administrators including their contact info, please click here.
Second, Drs. Matt Brengman and John Morton met with CMS in September 2012 to advocate for a change in reimbursement for out-patient sleeve. We are happy to report that CMS has decided to move the outpatient facility adjustable gastric banding to a higher paying APC from 0131 ($3,497) to 0132 ($5,268). Here is the link to the final rule: http://www.ofr.gov/OFRUpload/OFRData/2012-26902_PI.pdf. See pages 433-436.
Finally, the ASMBS has partnered with the Obesity Care Continuum to advocate for obesity care coverage in the Essential Healthcare Benefit package. The Secretary for Health and Human Services, Kathleen Sebelius, must approve each state plan and ASMBS Access and the Obesity Care Continuum with our Washington liaison Chris Gallagher has sent a letter to Secretary Sebelius strongly advising to have obesity care coverage in each state plan. ASMBS Access has also advocated for obesity care coverage in each individual state as well. The Obesity Care Continuum includes many of our partners for Obesity Week November 11-16, 2013 in Atlanta, GA. Please see our joint letter here.