APAPO supports Medicare bill making psychologists eligible to provide obesity services

The Medicare obesity preventive care service is currently limited to primary care physicians and other primary care practitioners.

On Nov. 4, the APA Practice Organization (APAPO) sent a letter (PDF, 110KB) to Senators Tom Carper, D-Del., and Lisa Murkowski, R-Ark., in support of the Treat and Reduce Obesity Act (S. 1184), legislation that would help increase Medicare coverage of obesity treatments, prevent chronic diseases and lower health care costs. The legislation gives the Centers for Medicare and Medicaid Services (CMS) authority to expand the Medicare benefit for Intensive Behavioral Therapy (IBT) for Obesity by allowing additional types of providers to offer the service.

The IBT for obesity benefit, a Medicare preventive care service for beneficiaries with a defined Body Mass Index (BMI) equal to or greater than 30 kg/m2, is currently limited to primary care physicians and other primary care practitioners. The Senate version of the bill expressly includes clinical psychologists among other nonphysician providers in the list of additional professionals eligible to offer IBT. For the newly added nonphysician providers, the IBT benefit would be furnished upon referral from and in coordination with a physician or primary care physician.

Under the benefit, eligible patients receive a specific number of face-to-face visits per month for six months, with additional visits up to a year based on a reassessment of obesity and determination of 6.6lbs of weight loss. In addition to BMI screening and a nutritional assessment, IBT for obesity includes intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise. Eligible providers of IBT for obesity will use Healthcare Common Procedure Coding System (HCPCS) code G0447, Face-to-Face Behavioral Counseling for Obesity, 15 minutes and one of the ICD-9 codes for BMI of 30.0 and over.

Obesity is a national health concern that contributes to the risk of developing other chronic, and often costly, health conditions including diabetes, depression and heart disease. The legislation will tap into psychologists as experts in the diagnosis, assessment and treatment of health risk behaviors like obesity through behavioral interventions and counseling programs.

The legislation would also:

  • Require CMS to include information on coverage of intensive behavioral counseling for obesity for Medicare beneficiaries in the Medicare and You handbook.
  • Allow CMS to expand Medicare Part D to provide coverage of FDA-approved prescription drugs for chronic weight management.
  • Require the secretary of the US Department of Health and Human Services (HHS) to develop and implement a plan to coordinate HHS agencies’ programs to treat, reduce and prevent obesity in the adult population.

In a Sept. 2011 letter to CMS (PDF, 49KB), APAPO argued it was an oversight to not include psychologists as providers of behavioral services for obesity and called for the provision of such services to not be limited to primary care settings.

“As key Medicare mental and behavioral health service providers, psychologists are well positioned to promote health behavior change,” says APA Executive Director for Professional Practice Katherine C. Nordal, PhD. “We are committed to expanding psychology’s role in advancing a patient’s overall health and promoting health behavior change.”

The bill is currently pending in the Senate Finance Committee. APAPO will continue to track this bill and keep members apprised of significant changes through the PracticeUpdate e-newsletter.