Biopsychosocial Treatment of Obesity for Youth and Adults

PURPOSE: This rule establishes the MO HealthNet payment policy for the biopsychosocial treatment of obesity for youth and adult participants. The goal of this policy is to improve health outcomes for both the youth and adult population by managing obesity and associated co-morbidities. PUBLISHER’S NOTE: The secretary of state has determined that publication of the entire text of the material that is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here. (1) Administration. The MO HealthNet Division, Department of Social Services, shall administer Biopsychosocial Treatment of Obesity for Youth and Adult participants. Biopsychosocial treatment of obesity services covered and not covered, the limitations under which services are covered, and the max imum allowable fees for all covered services shall be deter mined by the MO HealthNet Division and shall be included in the MO HealthNet Physician Provider Manual and Behavioral Health Services Manual. The MO HealthNet Physician Provider Manual is incorporated by reference and made part of this rule as published by the Department of Social Services, MO HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, May 6, 2025, and available at https://mydss.mo.gov/ media/pdf/physicians-provider-manual. This rule does not in corporate any subsequent amendments or additions. The MO HealthNet Behavioral Health Services Provider Manual is incorporated by reference and made part of this rule as pub lished by the Department of Social Services, MO HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, May 2, 2025, and available at https://mydss.mo.gov/media/pdf/behav ioral-health-services-manual. This rule does not incorporate any subsequent amendments or additions. Biopsychosocial treatment of obesity services covered by the MO HealthNet program shall include only those which are shown to be med ically necessary. (A) In the administration of the rule, the following defini tions are used: 1. “Biopsychosocial Treatment of Obesity” means using a combination of obesity screenings and Intensive Behavioral Therapy (IBT) to promote lifestyle changes leading to weight loss for adult participants, and weight loss or weight stabiliza tion for youth participants. Medical Nutrition Therapy (MNT) is a recommended but optional component of the treatment. A. “Adult Intensive Behavioral Therapy (IBT)” means obesity management by utilizing intensive multicomponent, behavior-based weight loss interventions that promote and sustain weight loss in adult participants. B. “Youth Intensive Behavioral Therapy (IBT)” means obesity management by utilizing comprehensive, intensive behavior-based weight loss interventions that can include multi-component family-based behavioral treatment (FBT) interventions tailored to participant needs targeting both the parent/guardian and the youth; 2. “Body Mass Index (BMI)” means a measure that relates body weight to height and is calculated by dividing weight in kilograms (kg) by the square of height in meters (expressed in kg/m2). A. “Body Mass Index (BMI) Percentile” means the range of BMI values as expressed in percentiles for age and gender as plotted on the pediatric BMI chart. B. “Pediatric Body Mass Index (BMI) Chart” means a graphic display of normal progressive changes in body mass index for the pediatric population ages two (2) to twenty (20) years of age; 3. “Medical Nutrition Therapy (MNT)” means nutritional diagnostic, therapy, and counseling services furnished by a licensed registered dietitian or registered dietitian nutritionist, and includes a review of nutritional health, eating habits, and development of an individualized nutrition plan; and 4. “Qualified University” means a United States regionally accredited college, university, or foreign equivalent, or an ac ademic university-based medical center affiliated with such a university. (2) Provider Participation. To be eligible to provide services for the MO HealthNet Biopsychosocial Treatment of Obesity Program— (A) All Biopsychosocial Treatment of Obesity service provid ers must be enrolled as MO HealthNet providers; (B) To provide MNT for obesity, a practitioner is required to meet the following criteria: 1. Have a current license to practice as a Licensed Registered Dietitian or Registered Dietitian Nutritionist in the state in which they practice; 2. Meet one (1) of the following requirements: A. Have a minimum of one thousand (1,000) hours of experience delivering weight management treatment for in dividuals, families, or youth with obesity within the past five (5) years; B. Earned a Commission on Dietetic Registration (CDR) Certificate of Training in Obesity for Pediatrics and Adults; C. Earned a CDR Specialist Certification in Obesity and Weight Management (CSOWM); D. Earned a CDR Adult Weight Management Certificate of Training; E. Earned a CDR Childhood and Adolescent Weight Management Certificate of Training; or F. Completed a state qualified training program in obe sity treatment for adults and/or children; and 3. Once certification is obtained, licensed dietitians who provide MNT under this program must complete a minimum of three (3) hours of continuing education specific to obesity or weight management every two (2) years; (C) To provide individual and/or group IBT and/or FBT, a prac titioner is required to meet the following criteria: 1. Have a current license to practice as one (1) of the following provider types: psychiatrist, clinical social worker, psychologist, or professional counselor, marital and family therapist, or psychiatric advanced practice registered nurse. Licensed dietitians are eligible to provide group IBT and/or FBT if they meet the requirements of paragraphs (2)(C)2.B. and (2) (C)3. of this rule; 2. Meet one (1) of the following requirements: A. Have one thousand (1,000) hours of experience deliv ering weight management behavioral treatment for individu als, families, and/or youth with obesity within the past five (5) years; or B. Complete a qualified training program that addresses delivery of behaviorally based intervention for adult and/or youth participants diagnosed with obesity; and 3. Once certification is obtained, licensed professionals who provide IBT and/or FBT under this program must complete a minimum of six (6) hours of continuing education credits specific to obesity or weight management every two (2) years for the patient population served, either youth or adult or both. (3) Participant Criteria. Any person who is determined eligible for MO HealthNet benefits by the Family Support Division and who also meets the following criteria shall be deemed eligible to receive these services: (A) Be under twenty-one (21) years of age for youth services or twenty-one (21) years of age or older for adult services; (B) Not currently pregnant; and (C) Have obesity by meeting the following criteria: 1. For youth participants a body mass index (BMI) percen tile equal to or greater than the ninety-fifth (95th) percentile for age and gender on the pediatric body mass index (BMI) chart; and 2. For adult participants a body mass index (BMI) equal to or greater than thirty (30). (4) Biopsychosocial Treatment of Obesity Services. (A) Biopsychosocial Treatment of Obesity Services provide behavioral health and, whenever possible, adjunctive medical nutrition therapy services, coordinated by the primary care or referring physician, or other licensed practitioner of the heal ing arts, to facilitate behavior change to manage obesity and associated co-morbidities. Biopsychosocial treatment of obe sity requires a referral from a physician or other practitioner of the healing arts as part of an office visit for evaluation and management. 1. The youth benefit includes a twelve- (12-) month period of intervention with a maximum of— A. Five (5) hours of individual IBT; B. Twenty-four (24) hours of group IBT; and C. Two (2) hours and fifteen (15) minutes of MNT. 2. If the youth is not making adequate progress with weight loss or weight stabilization, the IBT provider shall consult with the referring provider who shall perform the necessary lab work to rule out the presence of other conditions (e.g., endocrine disorder) that may complicate weight management and, if present, shall treat the medical condition while the youth continues to participate in the biopsychosocial treatment. 3. The adult benefit includes a twelve- (12-) month period of intervention with a maximum of— A. Four (4) hours of individual IBT; B. Eleven (11) hours of group IBT; and C. Two (2) hours and fifteen (15) minutes of MNT. 4. If the adult is not making adequate progress with weight loss, the IBT provider shall consult with the referring provider who shall perform the necessary lab work to rule out the presence of other conditions (e.g., endocrine disorder) that may complicate efforts to reduce weight and, if present, shall treat the medical condition while the adult continues to participate in the biopsychosocial treatment. (5) Documentation Requirements for Biopsychosocial Treatment of Obesity. (A) The participant’s treatment record shall contain the fol lowing documentation, at a minimum: 1. The referring provider’s referral; 2. The medical nutritional assessment completed by the dietitian, if participant is receiving MNT services; 3. The initial behavioral assessment completed by the behavioral health practitioner; 4. Progress notes that include the following information from each visit: A. A measured weight and calculated BMI for adult participants or BMI percentile for youth participants; B. Progress the youth/parent/participant is making towards weight management goals; C. Challenges (e.g., social determinants) the participant is facing and proposed solutions; D. Recommendations for treatment/care plans; and E. Collaborative efforts between the providers delivering primary care; MNT, if applicable; and IBT; 5. A final evaluation report detailing the extent of health ier weight over the treatment period, progress with metabolic, social, and behavior change endpoints, challenges to main taining healthier weight, and any future recommendations for maintaining a healthier weight in the context of identified challenges. The evaluation shall be shared with the referring provider. (6) Reimbursement Methodology. (A) MO HealthNet provides reimbursement to enrolled practitioners delivering biopsychosocial treatment of obesity for youth and adults and who are currently licensed, certified, and in good standing with the state. (B) Reimbursement for services is made on a fee-for-services basis. The maximum allowable fee for a unit of service has been determined by MO HealthNet to be a reasonable fee, con sistent with efficiency, economy, and quality of care. Payment for covered services is the lower of the provider’s actual billed charge (should be the provider’s usual and customary charge to the general public for the service), or the maximum allow able per unit of service. AUTHORITY: sections 208.201 and 660.017, RSMo 2016, and sec tion 208.152, RSMo Supp. 2024.* Original rule filed Aug. 27, 2020, effective March 30, 2021. Amended: Filed March 10, 2025, effective Oct. 30, 2025. *Original authority: 208.152, RSMo 1967, amended 1969, 1971, 1972, 1973, 1975, 1977, 1978, 1981, 1986, 1988, 1990, 1992, 1993, 2004, 2005, 2007, 2011, 2013, 2014, 2015, 2016, 2018, 2021, 2023, 2024; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995.