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Bariatric Surgery Centers of Excellence Program 
November 2007

The significant growth in the popularity of bariatric surgery, and concern for its inherent risks, have led to a focus on quality of care. As a result, accreditation is emerging as a quality standard for facilities in which bariatric surgery is performed.

In response, Harvard Pilgrim plans to introduce a new medical quality initiative to help ensure quality of care for our members requiring weight loss surgery. Under the program, members will be directed to designated facilities, known as Centers of Excellence, which will provide access to well-integrated programs focused on patient health and safety, as well as cross-functional team support.

The goal of the Centers of Excellence program is to ensure that members receive care from only those facilities and clinicians who have met stringent quality criteria, as established by the American College of Surgeons (ACS) and the American Society of Bariatric Surgery (ASBS). By meeting these requirements, designated facilities have demonstrated the best outcomes and are able to provide members with the consistent, high-quality care that their complex conditions require.

Harvard Pilgrim's Centers of Excellence program follows guidelines similar to those established by the Centers for Medicare and Medicaid Services (CMS). Like CMS, Harvard Pilgrim will cover bariatric surgery at contracted facilities certified by the ACS, or the ASBS. Our bariatric surgery Centers of Excellence program will be inaugurated in Massachusetts and New Hampshire on January 1, 2008. The program is currently pending approval of state regulators, as required, in New Hampshire, Maine and Rhode Island. Network Leader will provide updates to regulatory actions as they become available.

To be covered for bariatric surgery, the Harvard Pilgrim member's plan must provide for this benefit, and the member's condition must meet Harvard Pilgrim's clinical coverage guidelines. Bariatric surgery procedures that we authorize after December 31, 2007 must be performed at a facility recognized by Harvard Pilgrim as a Center of Excellence to be covered for HMO members, and to be covered at the lower cost-sharing amounts for POS and PPO members. This program does not affect bariatric procedures that are approved before January 1, 2008, regardless of when the surgery is scheduled.

Visit www.harvardpilgrim.org/providers to access a current list of Harvard Pilgrim's Bariatric Surgery Centers of Excellence. For more information about Harvard Pilgrim's Centers of Excellence program, contact the Provider Call Center at 800-708-4414.

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