CMS looks to expand access to new technology

The Centers for Medicare & Medicaid Services (CMS) said Wednesday that it is “committed to making new technology accessible to Medicare beneficiaries,” and to that end the agency will “consider policy To that end, in the coming months, we will begin creating rules for notifications and comments.” option.

In its opinion on health care and law, also published Wednesday in JAMA Internal Medicine, CMS said the pathway “builds on previous initiatives, including coverage by evidence development,” and the four policies outlined in the article. We expect you to meet our principles.

As a result, health technology policy advocates in Washington are likely one step closer in their efforts to curtail what the group has identified as the overuse of previous approvals. Beneficiary.

HR 3173 passed the U.S. House of Representatives earlier this month, and the Medical Device Manufacturers Association (MDMA) issued a statement applauding the decision and supporting passage of the bill. The bill is now going to the Senate.

MDMA submitted a statement to CMS Administrator Chiquita Brooks-LaSure’s previous Request for Information (RFI) issued on August 22, seeking feedback specifically on the Medicare Advantage program.

The issue has been debated and considered in legislation since its introduction on June 5, 2019 by Rep. Susan K. DelBene (D-WA) as HR 3107.

But there is another concurrent effort to change MA plans through rulemaking in CMS. AdvaMed sent its own letter to his Brooks-LaSure CMS administrator on his Aug. 1, before his HR 3173 passed in the House. A letter signed by Chandra N. Branham urged CMS: [TCET] rule this year. “

Branham is AdvaMed’s senior vice president and responsible for payment and care delivery policies.

MDMA submitted a statement to CMS Administrator Chiquita Brooks-LaSure’s previous Request for Information (RFI) issued on August 22, seeking feedback specifically on the Medicare Advantage program.

In an August 30 letter to CMS, MDMA suggested:

“MDMA’s mission is to provide patients with timely access to the latest safe and effective medical technologies that improve health outcomes,” said Mark Leahy, President and CEO of MDMA, CMS RFI. wrote in the organization’s reply of August 30 to

Leahey writes about its significance, citing that the Medicare Payment Advisory Commission estimates that nearly half, or 49%, of all Medicare beneficiaries are enrolled in a Medicare Advantage plan. Because “a high percentage of the dual-entitled minority population is enrolled in the MA plan,” it raises questions about equity if a participant or beneficiary “encounters access issues” by her MA policy . To evaluate his 2021 study, published by the Commonwealth Fund, he suggested traditional paying Medicare beneficiaries give higher scores on the index.

The American Health Insurance Program (AHIP), also based in Washington, DC, has passed the first hurdle of HR 3173 and is also participating in the entry process with a slightly different perspective.

“Physicians and clinicians provide critical care and life-saving treatments. We agree,” said David L. Allen, AHIP’s Director of Communications and Public a statement provided to MD+DI.

According to Allen, preapproval is “a key solution to ensuring that the care patients receive through Medicare Advantage coverage is safe, effective, proven and affordable. Medicare Advantage offers just that.” Protecting the value of MA is essential as we work together to further improve our previous approval process.”

I.eahey also wrote: In particular, “CMS should require MA organizations to comply with the current policy in the Medicare Managed Care Manual, which states that compensation policies “rely on credible evidence for objective evidence-based evidence.” ” and not use the accompanying grounds. “

The letter from Leahey also states that MDMA members “when applying the policies developed by MA plans, those policies often lack a clear basis for making decisions about patient care.” increase.

Furthermore, Leahey writes, CMS “should require MA organizations to solicit and respond to public comment on coverage policies and publish final policies.” Leahey also argued that MA organizations “must inform subscribers of the process of developing a compensation policy and of the opportunity to participate in that process.”

“Transparency and the opportunity for comment are essential to the development and implementation of compensation policies that enable adequate access to care,” Leahey concluded.

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