Prepared by Christopher Gallagher, OCC Washington Representative
Advocates Virtually Swarm Capitol Hill in Support of TROA
During Obesity Care Week (OCW), advocates from both inside and outside of the obesity community participated in roughly 100 congressional visits — urging House and Senate offices to support passage of the Treat and Reduce Obesity Act (TROA). The OCW advocacy push came as TROA passed the critical milestone of 150 total supporters in the House and Senate! Please go to the OAC’s Action Center and tell your representative and senators to support TROA!
CMS Again Signals its Reluctance to Act Administratively on TROA On February 1, 2022, the Centers for Medicare & Medicaid Services (CMS) finally responded to a July 1, 2020 letter from TROA Senate champions Bill Cassidy (R-LA) and Tom Carper (D-DE), which urged the agency to use its regulatory authority to implement the provisions of the legislation. Unfortunately, CMS once again responded that the agency “has explored AOM coverage under Part D; however, the statute excludes ‘agents when used for anorexia, weight loss, or weight gain’ from the definition of a Part D drug.”
The July 1, 2020 Carper/Cassidy letter also stated that, “given the consistent findings of the USPSTF that referrals out of the primary care setting for behavioral interventions for obesity are evidence-based, we urge CMS to revisit its 2011 Intensive Behavioral Therapy for Obesity (IBTO) coverage determination, particularly as it relates to the location and provider type restrictions. Frustratingly, CMS responded that “We note that the 2018 United States Preventive Services Task Force recommendation does not conclusively identify appropriate settings outside of the primary care setting in which IBTO services should be furnished. NCDs aim to provide access to needed services that ensure optimal patient outcomes and benefits by establishing coverage parameters based on the available evidence. We will continue to monitor available evidence addressing IBTO furnished outside of the primary care setting by non-primary care practitioners to determine whether a reconsideration of the NCD would be appropriate.”
Wisconsin Obesity Groups Push for State Employee IBT and Drug Coverage On February 16, 2022, the Wisconsin Employee Trust Funds’ (ETF) Group Insurance Board (GIB) held its first board meeting of the year to begin evaluating changes for state employee health benefit coverage for 2023. On January 14th, the Wisconsin State Chapter of the American Society for Metabolic and Bariatric Surgery, Wisconsin Academy of Nutrition and Dietetics and the Obesity Action Coalition submitted comments to the GIB — urging Board members to adopt state employee health plan coverage for pharmacotherapy and medical nutrition therapy (aka nutrition counseling) for the treatment of overweight or obesity. Between now and the Board’s next meeting on May 18th, obesity advocates will be generating letters of support for expanding obesity care benefits. We encourage any Wisconsin state employees who wish to speak in favor of expanding benefits to please contact Chris Gallagher at firstname.lastname@example.org.
Ohio State Medical Board Proposes Less Restrictive Prescribing Rules On February 11, 2002, the State Medical Board of Ohio (SMBO) published new proposed rules (4731-11-04) for public comment, entitled “Controlled substances for the treatment of obesity.” The proposed rule represents a good step in the right direction by eliminating the old regulations that limited medication to short-term use — especially given that obesity is a chronic disease and this change will now allow the current standard of care to be provided for many more Ohio patients living with obesity. That being said, the obesity community still has several concerns with the proposed language where we think it is overly prescriptive and will still represent a barrier to care for many patients, particularly those with difficult to treat obesity. At the time of this report, obesity advocates were finalizing public comments to the SMBO regarding the new proposed regulations.
Virginia Senate Committee Approves Bill to Require Study on Obesity On February 24, 2022, the Virginia Senate Committee on Education and Health unanimously approved legislation to “require the Joint Commission on Health Care (JCHC) to study and provide recommendations related to the payment of medical assistance for obesity prevention and other obesity-related services.” Specifically, the legislation would require the JCHC to study and provide recommendations related to (i) the types of obesity prevention and other obesity-related services for which federal matching funds are available, (ii) the cost to the Commonwealth of providing medical assistance for such obesity prevention and other obesity-related services for eligible individuals, and (iii) any federal approvals or other actions necessary to allow for the payment of medical assistance for obesity prevention and other obesity-related services. Should the legislation be signed into law, the JCHC would report its findings and recommendations to the Governor and the Chairmen of the House Committees on Appropriations and Health, Welfare and Institutions and the Senate Committees on Finance and Appropriations and Education and Health by November 1, 2022. HB 1098, which has been sponsored by Delegate Guzman, has already unanimously passed the Virginia House. The version of HB 1098 that was reported out of the Senate Committee on Health and Education made a change to the House-passed version — requiring the JCHC, instead of the Department of Medical Assistance Services, to conduct the study. OMA advocate Dr. Cate Varney coordinated a meeting with Delegate Guzman’s Policy staff prior to the Senate committee vote and offered any and all support from the obesity community to help the legislation achieve final passage.