HF 5474 Summary

• Health plans must cover obesity diagnosis and treatment including intensive behavioral or lifestyle therapy, metabolic and bariatric surgery, and FDA-approved antiobesity medications effective January 1, 2025.

• Coverage criteria for FDA-approved antiobesity medications cannot be more restrictive than FDA-approved indications for these treatments.

• Obesity coverage must have the same cost-sharing terms (deductibles, copayments, coinsurance, benefit maximums) as coverage for any other illness or condition.

• Health plans may apply utilization management to determine medical necessity for obesity treatment using the same standards applied to other covered illnesses.

• Medical assistance must cover obesity management and treatment in the same manner as required for health plans, and the Department of Human Services must report annually on obesity prevalence, diagnosis rates, service utilization, and health improvements including diabetes prevention and cardiovascular health outcomes.