Representatives Jerrold Nadler (D-NY), J.D. Hayworth (R-AZ), and Lois Capps (D-CA) today applauded the Centers for Medicare and Medicaid Services (CMS) for their draft proposal to modify Medicare coverage of bariatric surgery.  The Representatives called the decision a positive step that will help reduce the significant health risks associated with obesity among the Medicare population.

CMS’s proposed national coverage decision for Medicare beneficiaries under age 65 includes certain gastric bypass procedures when performed under specified clinical circumstances and in a facility meeting proposed standards for bariatric surgery.  CMS will consider expanding coverage to include elderly patients over the age of 65, and other procedures, as part of a formal evidence-based process.

“This draft decision by CMS shows that the federal government accepts bariatric surgery as a safe, effective treatment for morbid obesity – and it should encourage insurers across the country to follow their lead,” said Congressman Nadler.  “As the obesity epidemic continues to raise health care costs, Medicare coverage for bariatric surgery will help eligible patients get the life-saving treatment they need.”

“Today’s announcement by CMS of a draft NCD to cover adjustable gastric banding and gastric bypass represents a significant first milestone in the acceptance of the safety and efficacy of these procedures for the morbidly obese,” added Congressman Hayworth.  “We look forward to continuing to work with CMS to complete the final phases of this process and to complete the evidence based process to continue to expand the availability of bariatric surgery to those patients in need.”

“Last year the three of us joined with patients, physicians and manufacturers to urge CMS to take this first step.  We are gratified that CMS heard the call and has taken this action.  It is how the health care process is designed to work for all Americans,” said Congresswoman Capps.

On November 23, 2005, a 30-day public comment period commenced on the proposed NCD following the publication of the draft policy.  A final determination is expected 60 days after the close of the public comment period.