CMS Offers Draft Guidance on National Coverage Determinations

BALTIMORE–CMS has begun an effort to show how the agency
considers what new products and services to cover–and not to
cover–under the Medicare benefit.

Last week, the agency released three guidance documents on ways
to improve the Medicare National Coverage Determination process.
The documents detail steps the agency takes in determining whether
products or services are “reasonable and necessary for coverage as
a Medicare benefit,” CMS said in a statement. Among other
specifics, the drafts explain factors the agency considers when
deciding to open an NCD, when to commission external health
technology assessments and when it refers issues to the Medicare
Coverage Advisory Committee, an independent panel of medical
experts.

CMS is asking for comments on the drafts during a 60-day period
that began March 9.

“This is the continuation of our ongoing efforts to make the
Medicare coverage decision process more transparent, responsive and
effective,” said CMS Administrator Mark McClellan. “We want
comments on these draft guidance documents to help us make sure
that Medicare beneficiaries get prompt access to technologies that
can improve their health, and that technology developers have a
clear understanding of our coverage process.”

The drafts can be accessed on the CMS Web site by clicking
here.