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
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.
July 6, 2011
HUMAN SERVICES DEPARTMENT 
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.
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.
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).
After analysis and review of this rule making, no impact on jobs has been found.
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).
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).