Access Update | March 2013

HEADLINES

  • HHS Releases Final Rule on Exchanges and Essential Health Benefits & OPM Releases Final Rule on Multi-State Plans…
  • Bottom Line…Obesity Treatment Services Largely Ignored!

Editor: Christopher Gallagher, Director of ASMBS Washington Office
March, 2013, Volume 3, Issue 3

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Obama Administration Fails to Respond to Obesity Community’s
Call for Coverage of Obesity Treatments Services in State Exchange
or Multi-State Health Plans

On March 1, 2013, the Obama Administration released final regulations governing state health exchanges and guidelines for state essential health benefit (EHB) benchmark plans as well as final regulations for Multi-State Plans
(MSP). The former were issued by the Department of Health and Human Services (HHS) while the latter came out of the Office of Personnel Management (OPM).

In both cases, large coalitions, spearheaded by the obesity community, submitted comments to these federal agencies encouraging them to adopt regulatory approaches that would ensure patient access to comprehensive evidence-based obesity treatment services. Unfortunately, both HHS and OPM chose to ignore, or not directly respond to the coalition’s comments (December 24, 2012, coalition joint comment letter on EHB proposed rule & January 4, 2013, coalition joint comment letter on MSPs)

 

HHS Final Regulations on EHB

Sadly, HHS chose to ignore the December 24th comments of the coalition and did not even mention or address the specific request of the coalition that HHS “protect patient access to medically necessary obesity prevention and treatment services. Specifically, we request that HHS define management of obesity and metabolic disorders as part of “chronic disease management” within Item #9 Preventive and wellness services and chronic disease
management.

The large coalition that issued this request for clarification by HHS regarding obesity treatment’s role as an essential health benefit, included: the American Society for Metabolic and Bariatric Surgery, American Society of Bariatric Physicians, American Association of Clinical Endocrinologists, American Institute for Cancer Research, Academy of Nutrition and Dietetics, Campaign to End Obesity Action Fund, Mental Health America, National Alliance for Mental Illness, Obesity Action Coalition, and The Obesity Society.

 

OPM Final Regulations on Multi-State Plans

In the case of the final regulations on Multi-State Plans, OPM did reference the comments of the obesity community, which expressed support for issuers of multi-state plans to adopt one of the OPM’s designated benchmark plans (Blue Cross Blue Shield (BCBS) Standard Option, BCBS Basic Option, and Government Employees Health Association (GEHA) Standard Option), as individuals affected by obesity would have access to critical obesity treatment services, such as bariatric surgery and nutritional counseling – some of the critical treatment avenues along the obesity care continuum. The obesity community comment letter also cautioned that such a coverage approach would still leave major treatment gaps in the care continuum such as coverage for a robust schedule of intensive, multi-component behavioral interventions and FDA-approved obesity drugs.

In the OPM final rule, the agency included the following brief analysis and “non-response” to the above mentioned obesity community comments:

“Comments: Some commenters noted that differences between an OPMselected benchmark and State-selected benchmark are unlikely to be actuarially significant. Some commenters also noted that the proposed policy would encourage issuers to participate in the MSPP. Other commenters also noted that OPM-selected benchmarks would provide robust prescription drug coverage, obesity treatment services, medical nutrition therapy, pediatric services, and chiropractic care.

Response: We agree with commenters who noted that the differences between an OPM-selected benchmark and State-selected benchmark are unlikely to be actuarially significant. We are not aware of any compelling evidence that multiple benchmarks would lead to adverse selection or consumer confusion, nor did the commenters produce any evidence of adverse selection or consumer confusion. Accordingly, we are adopting as final the proposed provision to allow an MSPP issuer to offer a benefits package in all States that is substantially equal to either the EHB-benchmark plan in each State in which it proposes to offer an MSP or any EHB-benchmark plan selected by OPM.”

At press time, leadership from the obesity community were reaching out to both the Department of Health and Human Services and the Office of Personnel Management in order to meet with both agencies regarding HHS and OPM’s failure to adequately address the concerns of so many stakeholder groups on this critical issue of patient access to, and coverage of, obesity treatment services.

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