The road to overcoming obesity rates has been filled with speed bumps. But thanks to  Medicare, patients will have to work even harder to receive coverage for bariatric surgery.

According to the a memorandum released by Centers for Medicare & Medicaid Services (CMS), the agency has restructured the requirements for senior citizens to receive coverage for these weight loss procedures. Now, seniors will have to show a body mass index (BMI) of 35 to be considered “morbidly obese.” With this score, patients will qualify for coverage for bariatric surgery as a treatment for beneficiaries with type 2 (or “non-insulin-dependent”) diabetes. Beneficiaries afflicted with type 2 diabetes –  and BMI scores below 35 – would not receive coverage.

In 2006, Medicare beneficiaries were given access to expanded coverage for bariatric surgery. These patients had been required to undergo surgery from highly qualified surgeons that were certified by one of two governing organizations: the American College of Surgeons or the American Society for Bariatric Surgery. In addition, Medicare’s 2006 decision allowed for only four types of bariatric surgery procedures: gastric bypass; open and laparoscopic Roux-en-Y gastric bypass; laparoscopic adjustable gastric banding; and open and laparoscopic biliopancreatic diversion with duodenal switch.

With the new decision, Medicare beneficiaries must now exhibit a serious health condition, other than morbid obesity. These conditions may include osteoarthritis, hypertension, or coronary artery disease. Unfortunately, those patients with type 2 diabetes, but not considered morbidly obese, will not qualify for coverage. This new decision stems from Medicare’s position on the health benefits of bariatric surgery. Specifically, the agency believes that that there’s not enough evidence of these procedures’ effectiveness for  improving the health of  non-morbidly obese people.

Would you like to review the agency’s position, or submit your thoughts and comments? If so, the proposed decision is available on the CMS Coverage website.  Comments will be accepted for 30 days following the memorandum’s posting.  CMS will issue a final decision memorandum within 90 days of the proposed decision.