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TRICARE Program; surgery for morbid obesity. Final rule.

Federal Register

|February 26, 2011

Summary

This final rule updates TRICARE coverage for bariatric surgery by including newer procedures and using Body Mass Index (BMI) for obesity assessment. Non-surgical weight loss interventions remain excluded.

Area of Science:

Medical Policy and Regulations
Surgical Procedures
Obesity Management

Background:

Current TRICARE regulations for morbid obesity treatment are outdated.
Existing language limits coverage to specific bariatric surgical procedures.
There is a need to incorporate advancements in bariatric surgery and obesity measurement.

Purpose of the Study:

To revise the definition of morbid obesity and bariatric surgery for TRICARE beneficiaries.
To allow benefit consideration for newer, appropriate bariatric surgical procedures.
To update the assessment of excess weight using Body Mass Index (BMI).

Main Methods:

Amending definitions of Bariatric Surgery and Morbid Obesity.
Revising language to permit coverage for evolving surgical treatments.

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Removing specific limitations on surgical procedures for co-morbid conditions.

Retaining exclusion of non-surgical interventions for weight reduction.

Main Results:

The final rule broadens the scope of covered bariatric surgical procedures.
Body Mass Index (BMI) is established as the measure for excess weight.
Coverage is updated to reflect current medical practice and technological advancements.
Non-surgical weight loss interventions remain excluded from TRICARE benefits.

Conclusions:

The updated rule facilitates TRICARE coverage for advanced bariatric surgical procedures.
Utilizing BMI ensures a more accurate assessment of obesity-related health risks.
These changes allow the TRICARE Program to adapt to evolving medical technologies and treatments for morbid obesity.