25-15-25 - Program for treatment and management of obesity and related conditions; criteria for patient and facility program eligiblity [Repealed effective July 1, 2012]. - Mississippi Statutes

§ 25-15-25. Program for treatment and management of obesity and related conditions; criteria for patient and facility program eligiblity [Repealed effective July 1, 2012].
 

(1)  There is established a program designed to address the problem of the high rate of obesity in Mississippi, by providing for the treatment and management of obesity and related conditions through various methods, including, but not limited to, the use of bariatric surgery as a treatment option. The program shall be conducted by the State and School Employees Health Insurance Management Board (the "board") through the State and School Employees Health Insurance Plan as provided in this section. 

(2)  The board shall develop the criteria for patient and facility eligibility for the program, which shall include, but not be limited to, the American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic Bariatric Surgery (AACE/TOS/ASMBS) Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient. 

(3)  The criteria for patients to be eligible for bariatric surgery in the program shall include, but not be limited to: 

(a) A body mass index (BMI) of greater than forty (40), or greater than thirty-five (35) with two (2) co-morbidities such as diabetes, hypertension, gastroesophageal reflux disease (GERD), sleep apnea or asthma; 

(b) Participation in the State and School Employees Health Insurance Plan for at least one (1) year; and 

(c) Two (2) weight loss attempts documented with the patient's primary practitioner, using methods such as Weight Watchers, the Atkins diet, the South Beach diet or Sugar Busters, that have shown multiple attempts at sustained weight loss failure. 

(4)  The criteria for Mississippi medical centers and hospitals to be eligible for delivery of bariatric surgeries in the program shall be as follows: 

(a) Must be a nationally designated Center of Excellence, or must have reached the criteria for that designation and have the application awaiting approval and accepted by the board as sufficient; 

(b) Must meet other criteria developed by the board; and 

(c) Must have all the critical post-surgical patient support in place including, but not limited to: 

(i) A nutritionist/dietician for patient access; 

(ii) Individual and group support meetings; 

(iii) Development of personalized weight loss goals and management/support for lifelong life style changes; and 

(iv) A physical activity component. 

(5)  During the first year, the program shall approve not more than one hundred (100) patients from different regions in the state in the program based on the guidelines developed by the board. During the second year, the program shall approve not more than an additional one hundred (100) patients from different regions in the state in the program based on the same guidelines. At the end of the first two (2) years, the board shall report back to the Chairmen of the House Public Health and Human Services Committee and the Senate Public Health and Welfare Committee with detailed information on initial trends of the program. The required information shall include, but not be limited to: 

(a) Pre-surgical prescription costs for each patient associated with obesity and its co-morbidities; 

(b) Post-surgical prescription cost reductions associated with each patient's improved medical co-morbidities; 

(c) Co-morbidities documented before surgery and the resolution or improvement of those co-morbidities after surgery including, but not limited to: 

(i) Drug cost (expect to see a reduction or elimination of drug therapy as the co-morbid conditions improve/resolve as weight loss is achieved); 

(ii) Each patient serves as his or her own control, by comparing health care costs in the preceding two (2) years (while obese, and with co-morbid conditions) and then post surgery; and 

(iii) Productivity (expect to see increased productivity, such as less absenteeism and improved quality of work) that can be translated to cost savings in the total picture, not just health care dollars. 

(6)  To insure the least initial cost to the state in the first two (2) years of implementation of the program, seventy-five percent (75%) to eighty-five percent (85%) of participants should be eligible for lap bands or other gastric banding. 

(7)  Beginning on July 1, 2012, the benefits provided under this program shall become a full benefit for all participants in the State and School Employees Health Insurance Plan who are eligible for the program. 

(8)  This section shall stand repealed on July 1, 2012. 
 

Sources: Laws, 2009, ch. 434, § 1, eff from and after July 1, 2009.