The Centers for Medicare & Medicaid Services yesterday proposed repealing a final rule codifying how it defines “reasonable and necessary” coverage for items and services furnished under Medicare Parts A and B, which is scheduled to take effect Dec. 15. The final rule also establishes a Medicare coverage pathway for innovative medical devices designated as breakthrough by the Food and Drug Administration. Beginning tomorrow, CMS will accept comments for 30 days on the proposed repeal and the agency’s intent to conduct future rulemaking to explore the definition of “reasonable and necessary” coverage and an expedited coverage pathway for innovative beneficial technologies. 

In comments submitted last November, AHA warned against an earlier proposal that national and local Medicare coverage determinations consider the extent to which certain items or services are covered by a majority of commercial insurers, noting that such an approach could reduce coverage in the Medicare program and transparency in coverage determinations.
 

Related News Articles

Headline
The Centers for Medicare & Medicaid Aug. 15 announced it negotiated lower prices with drug makers for 10 high-cost, sole-source drugs, with the new prices…
Headline
The AHA, joined by five other national hospital associations, Aug. 14 filed an amicus brief urging the Supreme Court to correct the Department of Health and…
Headline
The AHA Aug. 13 commented to the Medicare Payment Advisory Commission in anticipation of the commission’s 2024-2025 cycle. The AHA urged MedPAC to carefully…
Headline
More than 46 million prior authorization requests were submitted to Medicare Advantage insurers in 2022, according to KFF analysis released Aug. 6 examining…
Headline
The AHA along with the Federation of American Hospitals, America’s Essential Hospitals and the Association of American Medical Colleges July 29 filed an amicus…
Headline
The Centers for Medicare & Medicaid Services July 16 released its final guidance on the Medicare Prescription Payment Plan which will begin next year. The…