SRC Counters Efforts to Reduce N.C. Medicaid Coverage

In June, SRC Board Chairman Walter J. Pories, M.D., assisted by SRC’s Strategic Alliances Group, met with the North Carolina Physicians’ Advisory Group to discuss new proposed changes to the Clinical Coverage Policy No. 1A-15 for bariatric surgery. The Advisory Group is a committee of the North Carolina Medical Society that advises the North Carolina Secretary of HHS on Medicaid policy.

• raising the minimum age of eligibility from 18 to 21 demanding evidence that the morbid obesity had been present at least five years requiring six months of a physician-supervised diet with documented monthly visits removing laparoscopy as a method for the insertion of bands disallowing adjustment of adjustable gastric bands disallowing revision for failure
• limiting bariatric surgery to one operation per lifetime

Dr. Pattie Forest, Medical Director of the North Carolina Department of Health and Human Services, Division of Medical Assistance, her staff and the members of the Physicians’ Advisory Group agreed with Dr. Pories’ and SRC’s evaluation of the proposed changes and their argument that the new rules would deny access of the only effective therapy for morbid obesity to the poor and minorities.

After thorough discussion, SRC is delighted to report that the North Carolina Physician’s Advisory Group unanimously voted not to accept the new changes, but rather retain the current rules as outlined by the National Institutes of Health in the 1994 Consensus Conference.

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