The proposed service authorization changes are not only too strict, they are much too difficult for the average person to comply with.  People on Medicaid are already having difficulty with finances.  Having to meet with another provider (nutritional counselor), is adding another financial burden.  Patients are already being counseled by their weight-loss provider (PCP, bariatrician, etc).  Why put an additional roadblock in their way if it's not absolutely necessary?Also, the BMI of 40 is in Bariatric Surgery territory.  Thank you.