Weight Loss

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WEIGHT LOSS

Advanced Weight Loss Systems Weight Loss Programs (October 24, 2002)
Weight Loss Programs (June 23, 1992)
HMR Program (March 1, 1991)
RE: OPTIFAST Weight Loss Program (February 4, 1991)
Guidelines Regarding KY DVR Purchase of Weight Loss Services (July 27, 1990)

SERVICE FEE MEMORANDUM

MS-CE-02-03-05

DATE: October 24, 2002

RE: Advanced Weight Loss Systems Weight Loss Programs

Reference SERVICE FEE MEMORANDUM MS-89-90-32, July 27 1990, Guidelines regarding KY DVR Purchase of Weight Loss Services.

DFB/DVR assistance cannot be provided with the Full Liquid OPTIFAST Program. During a very low calorie diet weight loss program (400 to 800 calories per day), such as the Full Liquid, DFB/DVR will only provide assistance with those programs that include weekly physician examinations. This program does not include weekly physician examinations.

Assistance can be provided with the following Modified Liquid OPTIFAST Program costs: physician examinations, lab work, EKG’s, and weekly office visits.

Assistance can be provided with the following Protein Plus Program costs: physician examinations, lab work, EKG’s, and weekly office visits when daily caloric intake is above 800. The consumer will have the option of starting this program at 784 calories per day or 871 calories per day. If the consumer chooses to start at 784 calories per day for Week 1 and 798 calories per day for Week 2, the consumer will be responsible for the $25.00 Office Visit for these two weeks. DFB/DVR will only cover Office Visit for weeks during which the calorie intake exceeds 800 calories per day.

DFB/DVR assistance with nutritional supplements (Modified: RTD and powder products Protein Plus: powder forms only) cannot be provided since nutritional supplements are considered a food grade item, not a drug item. Assistance with the Weight Management Program and/or Lifetime Membership cannot be covered as the costs of long-term maintenance programs are not covered. The consumer will be responsible for the costs of nutritional supplements/products, Weight Management Program, and/or Lifetime Membership.

The following allowable fees can be provided for the Modified Liquid OPTIFAST Program or the Protein Plus Program:

Code Initial Medical Fees Allowable Fees

99201 Initial Physician Examination $ 50.00

By Report Initial Labwork: Chem 12, CBC, Lipid, T-4 $ 95.00

93000 EKG $ 40.00

Repeat Medical Fees

99212 Physician Examination $ 25.00 x 2 = $ 50.00

By Report Lab Work: CBC, CHEM 12, Lipid $ 59.00

93000 EKG $ 40.00 x 2 = $ 80.00

99211 *Office Visit $ 18.75 x 25 weeks = $468.75

*NOTE: The Week 1 and Week 2 Office Visits will not be covered in the Protein Plus Program if the calorie intake is less than 800 calories per day.

SERVICE FEE MEMORANDUM

MS-91-92-16

DATE: June 23, 1992

RE: Weight Loss Programs

The following weight loss programs do not meet Department of Vocational Rehabilitation (DVR) guidelines for the purchase of weight loss services. Services may therefore not be purchased from any of these programs.

Diet Center

Family Weight Loss Center

Formu 3

Nutra Bolic Weight Reduction

Nutri System

Physicians Weight Loss Center

Weight Watchers

Beverly Hills Weight Loss Center

Refer to SFM MS-89-90-32, July 27, 1990 for guidelines regarding Kentucky DVR purchase of weight loss services.

Weight loss services may only be purchased from vendors with whom agreements for services have been established and/or updated since July 27, 1990. All agreements are to be established and/or reviewed and approved by me.

To date, the following programs have current agreements with DVR:

HMR Fasting Program, Danville, Frankfort, and Lexington

Medifast Weight Loss Program, Elizabethtown and Frankfort

OPTIFAST Weight Loss Program, Humana Hospital Suburban, Louisville

Sutkamp Clinic Weight Loss Program, Fort Thomas

OPTIFAST Weight Loss Program located at Lexington Clinic East in Lexington has canceled its agreement with DVR.

SERVICE FEE MEMORANDUM

MS-90-91-17

DATE: March 1, 1991

RE: HMR Program

The Department of Vocational Rehabilitation (DVR) has established guidelines and a fee schedule for the purchase of weight loss services through the HMR Fasting Program in Danville, Frankfort, and Lexington.

GUIDELINES

The established weight loss goal will be that which will enable the client to become vocationally active (functional) but not necessarily to reach his or her ideal body weight range.

During the Weight Loss Phase, an average loss of 3 to 5 pounds per week will be considered sufficient progress.

During either the Weight Loss Phase or Maintenance Phase, if client does not participate in required program activities or does not show sufficient progress each month, DVR payment for services will be terminated.

NOTE

The Maintenance Phase is 18 months in duration with weekly meetings. The actual chare to a private patient for Maintenance is $1,000 to be paid @ $250 per month during the first four months (DVR will be allowing $590 to be paid in the first four months). Should there be any possibility that the DVR client would be covering the cost of the Maintenance Phase, the client should be made aware of the commitment and cost involved prior to entry into the HRM program.

FEE SCHEDULE

EVALUATIONS

CODE	PROCEDURE	DVR MAXIMUM ALLOWABLE FEE
00041	Initial Medical Evaluation	$73.00
*93000	EKG with Interpretation	$32.00
Laboratory Work
80019	Chem 24	$25.00
80070	Thyroid Panel	15.00
85022	CBC with Differential	$10.00
85062	Coronary Risk Profile	$13.00
81000	Urinalysis	4.00

*Waived if done within 30 days and results made available to HMR Fasting Program.

TREATMENT

WEIGHT LOSS PHASE

CODE	PROCEDURE	DVR MAXIMUM ALLOWABLE FEE
By Report	Weekly Physician's & Nurse's Visit; Behavioral/Education Class	$32.00
Laboratory Work
80019	Chemistry 24 (Biweekly)	$25.00
85022	CBC with Differential (Every 4 Weeks)	10.00
81000	Urinalysis (Every 6 Weeks)	4.00
93000	EKG with Interpretation (Following Initial 35 Pounds Weight Loss and Thereafter at Every 25 Pounds Weight Loss)	32.00
BR	Nutritional Supplements	Not Covered

Issue agency authorizations (EP-8's) for Treatment monthly and invoice upon receipt of written report of test results, itemized bills, and monthly progress reports.

MAINTENANCE Total $580.00

(To Be Paid @ $145.00 per Month for First Four (4) Months)

Weekly Behavioral/Education Classes for Eighteen (18) Months and Necessary Medical Visits

EP-8's should be issued monthly for the first four (4) months of Maintenance and invoiced upon receipt of itemized bills and monthly progress reports. Following completion of the fourth month of Maintenance, only 3 additional progress reports are required at 6 months, 12 months, and 18 months.

AUTHORIZATIONS

VENDOR NUMBER:	V01011326001
VENDOR NAME AND ADDRESS:	HRM FASTING PROGRAM EPHRIAM MCDOWELL REG MED DANVILLE KY 40422
CONTACT PERSON:	Alis McLaughlin PHONE: 859-236-7356

VENDOR NUMBER:	V01011326
VENDOR NAME AND ADDRESS:	HRM FASTING PROGRAM KINGS DAUGHTER MEM HOSP FRANKFORT KY 40601
CONTACT PERSON:	Lynn Lloyd PHONE: 502-875-5240

VENDOR NUMBER:	V00157263013
VENDOR NAME AND ADDRESS:	HRM FASTING PROGRAM U OF K MED PLZ ROOM A115 LEXINGTON KY 40535
CONTACT PERSON:	Kathleen Sears PHONE: 859-233-6824

SERVICE FEE MEMORANDUM

MS-90-91-14

DATE: February 4, 1991

RE: OPTIFAST Weight Loss Program

Humana Hospital Suburban, Louisville KY

The Kentucky Department of Vocational Rehabilitation (DVR) has established a fee schedule for the purchase of weight loss services through the OPTIFAST Program at Humana Hospital Suburban, Louisville.

GUIDELINES

The established weight loss goal will be that which will enable the client to become vocationally functional but not necessarily to reach his or her ideal body weight range. Should the client choose to continue the program in order to reach a lower ideal body weight range, the client should be advised that DVR will not cover treatment costs incurred during such time.

During the Fasting Phase, an average loss of 2 to 3 pounds per week for women and 3 to 5 pounds for men will be considered sufficient progress.

If client does not participate in required program activities or does not show sufficient progress each month, DVR payment for services will be terminated.

FEE SCHEDULE

Materials, Supplies, and Nutritional Supplements are not covered by DVR.

As participation in Encore is optional, DVR will not provide coverage with Encore charges.

EVALUATION

CODE	PROCEDURE	DVR MAXIMUM ALLOWABLE FEE
00041	Physical Examination	$95.00
By Report	Nutritional Evaluation	25.00
93000	EKG	32.00
Laboratory Work
80018	Diagnostic Profile: Chem 18	$ 9.77
84435	Thyroid Profile	13.10
85024	CBC with Differential	14.00
80061	Lipid Profile	16.35
82270	Occult Blood (At Physician's Request	5.25
81000	Urinalysis	6.00

Issue authorization (EP-8) covering Evaluation prior to the provision of services and invoice upon receipt of an itemized bill and written report of findings and recommendations.

TREATMENT: *CORE Program (26 WEEKS)

CODE	PROCEDURE	DVR MAXIMUM ALLOWABLE FEE
By Report	Weekly Check-up by Physician and Group Counseling Session for 25 Weeks	$32.00 Per Week
By Report	Group Counseling Session, Week 26	16.00
93000	Electrocardiogram (When Necessary)	32.00
By Report	Nutritional Supplies	Not Covered
By report	Materials and Supplies	Not Covered
Laboratory Work
80018	Diagnostic Profile: Chem 18 (Wks. 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 24)	$ 9.77
85024	CBC with Differential (Wks. 3, 7, 11, 15, 19, 21, 24)	14.00
81000	Urinalysis (WKS. 3, 5, 7, 9, 11, 13, 17, 19, 21, 24)	6.00

TREATMENT: ENCORE Not Covered

*DVR assistance may be provided for repeated participation in the Core Program when necessary for attainment of the established weight loss goal which will enable the client to become vocationally functional.

Issue authorizations (EP-8's) for the Core Program (Fasting, Refeeding, and Stabilization Phases) monthly and invoice upon receipt of written report of test results, itemized bills, and monthly progress reports.

AUTHORIZATION

Authorizations (EP-8's) should be forwarded to Lynn Powell, Director of the OPTIFAST Program.

VENDOR NUMBER:	V00319269
VENDOR NAME AND ADDRESS:	HUMANA HOSPITAL 4001 DUTCHMANS LANE LOUISVILLE KY 40207
CONTACT PERSON:	Lynn Powell, Director PHONE: 502-893-1003

SERVICE FEE MEMORANDUM

MS-89-90-32

DATE: July 27, 1990

RE: Guidelines Regarding KY DVR Purchase of Weight Loss Services

With regard to Kentucky Department of Vocational Rehabilitation (DVR) purchase of weight loss services, the following guidelines have been established. These guidelines are effective immediately for any client not currently involved in a weight loss program. Clients currently receiving DVR assistance with weight loss services may be continued at current levels of assistance in their respective programs.

DVR assistance with any weight loss program may only be provided when the client's primary or secondary handicapping condition involves obesity. (Counselor's Manual, Section 360.2.06: A disability of obesity may be established if the individual's weight is at least double his/her ideal weight as defined by the Metropolitan Life Insurance Company's Desirable Weight Scale.).
Assistance may only be provided to enable the client to become (vocationally) functional for his/her vocational goal as identified in the IWRP, but not to reach an ideal body weight range.
Client participation in a weight loss program must be recommended by a physician based on current results of a physical examination and electrocardiogram. The client should be free of contraindicating conditions, including recent myocardial infraction; cardiac conduction disorder; history of cerebrovascular, renal, or hepatic disease; cancer; insulin-dependent diabetes; or significant psychiatric disturbance.
Only physician-directed weight loss programs which offer medical supervision throughout treatment are to be covered by DVR. During a very low calorie diet weight loss program (400 to 800 calories per day) fasting phase, medical supervision should include weekly physician examinations and biweekly blood work (electrolyte levels, etc.).
In any weight loss program, DVR assistance may be provided with physician examinations, clinic visits, nutritional evaluations and counseling by a registered dietitian, laboratory work, electrocardiograms, and prescription drugs.
DVR assistance with nutritional supplements may not be provided. Nutritional supplements are considered a food grade item, not a drug item, by the Food and Drug Administration.

This Service Fee memorandum takes precedence over all previous memorandums, correspondence, and agreements. Vendors with who agreements have been established will be notified of these guidelines. Service Fee memorandums and/or Memorandums will either be updated or nullified to bring into compliance with above-stated guidelines.

Services may be purchased only from vendors with whom agreements for services have been established. All agreements are to be established and/or reviewed and approved by me.