Medicaid drops lap band coverage!

Hi All.
Do you think the verbiage below is fair? Let me know.

The Governor's office of Iowa suspended Medicaid coverage for WLS largely on the grounds that WLS patients are non-compliant.

This is technically specific to Iowa & Medicaid, BUT, a wide range or payers (public and private) migh be impacted by the outcome, both in Iowa and elsewhere. 

Please help reach out with the message below to anyone you might know in Iowa. Thank you.

http://www.obesityhelp.com/forums/IA/4428012/Please-help-rev erse-WLS-coverage-suspension-in-Iowa-This/


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Hello.
I hope you are doing well at this stage of your journey! I'm reaching out to all of our members in Iowa regarding the decision for Iowa Medicaid to withdraw coverage for weight loss surgery.  If you could share this email with anyone who might be interested, we at ObesityHelp.com would greatly appreciate it.

If you or anyone you know near Des Moines can make it, a Medicaid advisory council will be meeting this Friday. (Their next meeting after that is Oct 21st). WLS is _not_ on their stated agenda (see the web page below), but such might have been prepared a while ago. We suspect you would have some opportunity to meet Advisory Council members  for the purpose of expressing to them your appreciation for their support (past, current, and future) of WLS over the years, independent of the governor's decision. Also, you might also learn what they think about the recent legislation and what their current recommendations might be.
http://www.ime.state.ia.us/MAAC/CAC_Index.html Friday 7/22/2011, 1pm-4pm, Iowa Medicaid Enterprise at 100 Army Post Road in Des Moines, Iowa (See meeting agenda on the URL above {scroll down to find} ). They meet every 3 to 4 months.

Thank you in advance for helping -- via whatever means -- show the world all that we can be, working together. I hope you won't mind if I possibly contact you on this issue once more, possibly next week.  Please share your thoughts:  http://www.obesityhelp.com/forums/IA/a,messageboard/board_id ,4814/ .

    Eric Klein
    Founder, ObesityHelp.com
    Making the Journey Together


================  DETAILS BELOW  ======================


Medicaid coverage cessation.
Starting August 1st, coverage for WLS in the state of Iowa will stop (see exact verbiage below). While this was merely part of highly politicized efforts to prevent a state government shut down, the language adopted was biased, citing patient non-compliance as a cause of standard surgical complications. Whether intentional or not, this paints the obese in a poor light and should be addressed.  Medicaid is responsible for a lot of long-term coverage and therefore should be at the forefront of example-setting. In recent years 45 out of 50 states have covered WLS, but if that number were to start slipping, other payers -- both public and private sector -- could be motivated to follow suit.  So even if you are not covered by Medicaid this could potentially impact -- for years to come -- your access, or that of your children or other loved ones -- to bariatric procedures such as revisions or potentially plastics.  So, one way or another, you probably have some personal stake in this.

How you can help.
Soon we plan to send some information you could use to contact the governor's office and other elected officials prior to upcoming hearings on the matter. Stay tuned for this. Today, however, I wanted to encourage you to consider (our apologies for the short notice, but we wanted to get this one as right as possible) attending a Medicaid Advisory meeting (details above).  Teresa LaMasters MD, FACS is one surgeon (who works in Des Moines) who intends to be there, potentially with some of her co-workers. If you can't make it there yourself, perhaps you have friends or relatives in the Des Moines area who could. They might have some opportunity to show support for pro-WLS committee members (listed in the annual reports below). Some of them might have advice for the WLS community.

Introducing the Clinical Advisory Committee (CAC).
"The IME Medical Services unit assembled the CAC. The CAC is charged with recommending clinically appropriate healthcare utilization management and coverage decisions for the medial assistance program and IowaCares population to the Department. "  Please take a moment to familiarize yourself with their recent support of weight loss surgery:  

   http://www.ime.state.ia.us/docs/SFY2009AnnualReport.pdf
   http://www.ime.state.ia.us/docs/SFY2008AnnualReport.pdf
   http://www.ime.state.ia.us/docs/SFY2007AnnualReport.pdf


They're certainly working to manage costs for WLS, along with many other things, but their work is very rational. They did really well, in particular, in years past by reducing a mandatory two year wait period for WLS to just six months. Chances are, one or more of these people live near you (they are listed within the annual reports above).

Take home pointy here is that in "emergency" legislation, the government of Iowa stopped WLS Medicaid coverage without -- it seems -- the input of its own Medicaid's Advisory Council.

At the very least, this could be an educational experience for you if you were to attend. Many of us who care are not near Iowa (I'm stuck here in Southern California, for example) but we do see this, ultimately, as a national issue.  Whether or not you are able to attend, please share your thoughts on the Iowa message board:

http://www.obesityhelp.com/forums/IA/a,messageboard/board_id ,4814/


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Additional Details Below
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Parking
Every visitor to IME must have the "IME VISITOR" sign on their dash if 
they park in the front lot at IME. This applies to everyone including 
State employees who do not work at the IME building. If you do not have 
the "IME VISITOR" sign visible in your car, you run the risk of getting 
an orange sticker on your car. After you have received three (3) 
stickers, your car can be towed. Parking in the back lot on Dickman Road 
does not require the "IME VISITOR" form.

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Full Statement - with inserted commentary (by Eric Klein).
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IOWA MEDICAID ENTERPRISE – 100 ARMY POST ROAD – DES MOINES, IOWA 50315-6241

  Cost Savings Strategy #12 SFY 12 Budget
Name: Elimination of Bariatric Surgery
Implementation Date: August 1, 2011 Summary:
Medicaid will eliminate coverage for bariatric surgery for the treatment of morbid obesity. This coverage elimination applies to all forms of this surgery, including, but not limited to the following: gastric bypass, lap-band, roux-en-y, etc. These services have always required pre-procedure review (i.e., prior authorization).
• All authorizations issued through July 31, 2011 will expire on October 31, 2011.
• All members and providers with an active authorization in place will be notified by letter of the expiration date.
• No new bariatric surgery services will be authorized after July 31, 2011. Informational Letter: The Informational Letter announcing this change will be # 1030 . All Informational Letters can be viewed at http://www.ime.state.ia.us/Providers/Bulletins.html.
Rules: Rules will be posted at http://www.dhs.state.ia.us/PolicyAnalysis/RulesPages/Dockets.htm. Not posted there yet as of 7/19/2011. July 6, 2011

HUMAN SERVICES DEPARTMENT [441]
Adopted and Filed Emergency
Pursuant to the authority of Iowa Code section 249A.4 and 2011 Iowa Acts, House File 649, section 10, subsection 20(a), the Department of Human Services amends Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services," Iowa Administrative Code.
These amendments eliminate Medicaid coverage for bariatric surgery, including gastric bypass, lap-band, and other methods. This change is one of the Medicaid cost containment strategies recommended by Governor Branstad. Legislation passed by the Eighty-Fourth General Assembly authorizes the Department to implement these recommendations. Note the term "Emergency".  This reflects current budgetary climates. (For some context... as the federal government heads towards potential default, the state of Minnesota just to the north of Iowa remains in a state of government shut down). This Governor-origin is consistent with the medicaid clinical advisory committee not having withdrawn its support for bariatric surgery.
Concerns with bariatric procedures include noncompliance and complications. Patients who are unprepared or noncompliant put themselves at increased risk of complications following weight loss surgery, as this is a lifelong commitment for the individual. Noncompliance can lead to multiple medical procedures to manage complications such as vitamin and mineral deficiency, dehydration, gallstones, bleeding stomach ulcers, hernias, kidney stones, hypoglycemia, blood clots in the legs, leaking at one of the staple lines in the stomach, pneumonia, narrowing of the opening between the stomach and the small intestine, and dumping syndrome. These repeat procedures add additional cost to an already expensive procedure.
Although weight-loss surgery can reduce or eliminate such conditions as diabetes, hypertension and hypercholesterolemia (and the need for treating these conditions with costly medications), a patient may have increased need for treatment in other areas. It has been noted that people who have had weight loss surgery also needed treatment for gastrointestinal-tract disorders, anemia and vitamin deficiency. This level of clinical detail is impressive. The point by point specificity (versus any typical "not enough data") opens the field up for transparent discussion of particular statements.  These amendments do not provide for waivers in specified situations because the savings assumed in the Department’s appropriations will not be achieved if waivers are provided. Requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441--1.8(17A,217). So there is apparently some due process for case by case appeals. After analysis and review of this rule making, no impact on jobs has been found. A perfunctory requirement, most likely. It very expressly claims no association between weight loss surgery and improved employability.
The Council on Human Services adopted these amendments on July 13, 2011.
The Department finds that notice and public participation are impracticable because the Department's appropriation for the fiscal year beginning July 1, 2011, assumes the implementation of the cost containment strategies recommended by the governor without delay for notice and public comment. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(3). Along with reference to "Emergency" further above, this implies that some potentially broad swath of internal assets may have been bypassed.
  The Department also finds, pursuant to Iowa Code section 17A.5(2)“b"(1), that the normal effective date of these amendments should be waived, as authorized by 2011 Iowa Acts, House File 649, section 10, subsection 20(a).
These amendments are also published herein under Notice of Intended Action as ARC 9xxxB to allow for public comment.
These amendments are intended to implement Iowa Code section 249A.4 and 2011 Iowa Acts, House File 649, section 10, subsection 20(a).
These amendments became effective August 1, 2011.
The following amendments are adopted.
ITEM 1. Adopt new
h. Services provided for intestinal or gastric bypass surgery for treatment of obesity. paragraph 78.1(1)“h" as follows:
ITEM 2. Rescind and reserve subrule 78.3(4).  
-------- Original Message --------

Subject:  Kindly seeking your insight regarding changes to weight loss surgery coverage.
Date:  Fri, 15 Jul 2011 13:22:14 -0700
From:  Eric Klein
To: [email protected]

Mrs. Andi Dykstra, RN, CPHQ.

We are a patient education organization. We're seeking any insight that you might kindly provide. Our economically challenged members in Iowa have, by the way, appreciated your service to them over the years -- for which we remain in your debt. Regarding the upcoming cessation of coverage for weight loss surgery, might you kindly address any of the following questions?

1) To what degree -- if any -- was this prompted by any uncommonly urgent cost cutting measures?
(Unlike its neighbor to the north, Iowa has not shut down 1/3 of its spending, but it was unclear how much such writing might have been on the wall, so to speak, in the current legislative climates (both federal and state levels).

2) Since scientific evidence and thinking evolves all the time, was the committee sensitive to any changes in data or findings from any particular external authoritative sources with respect to cost to benefit trade-offs? And/or, were there any insightful findings within its own data sets?  (Such could be informative to other state medicaid departments). In the past, for example, recommendations from Univ. of Iowa dept of public health and the federal AGRQ might have been used by the CAC to refine its support of weight loss surgery coverage.

3) Is there any formal process by which any observers or guests are welcome and/or allowed to attend the CAC meetings?

Thank you in advance for your attention.
Eric Klein
Founder, ObesityHelp.com