Medical-device associations are urging CMS to withdraw its proposal changing how Medicare determines if a service or item will be covered. In a proposed rule released in late August, CMS would modify Medicare’s long-standing standards for coverage. Currently, CMS considers a service for coverage if it’s a recognized Medicare benefit and “reasonable and necessary” for treatment or diagnosis, which isn’t currently defined. CMS is proposing to define the “reasonable and necessary” stipulation as meaning an item or service is safe and effective, not experimental and appropriate. CMS then gave appropriateness several definitions including if a service or item is currently covered by commercial insurance. Comment letters for the proposed rule were due Monday and stakeholders are pushing back.
Read the full article: Devicemakers, MedPAC Oppose CMS’ Proposed Coverage Determination Changes //
Source: https://www.modernhealthcare.com/law-regulation/devicemakers-medpac-oppose-cms-proposed-coverage-determination-changes