Medicare coverage decision methods unveiled

CMS sets out a more collaborative approach to approving new products and services.

By Markian Hawryluk, AMNews staff. Oct. 13, 2003.

Washington -- Citing lessons learned over the last three years, Medicare is trying to shine a little more light on its coverage decision-making process.

The agency was widely accused earlier this year of dragging its feet in bringing the latest medical technology to Medicare beneficiaries. The changes announced last month by the Centers for Medicare & Medicaid Services offer the chance for public comment on coverage determinations and attempt to speed decisions by setting time frames.

CMS Administrator Tom Scully said the moves should make the determination process more efficient and ensure that the agency has the relevant information at its disposal.

"Our goal is to make the latest advances in medical care available to Medicare beneficiaries more rapidly, while making evidence-based decisions that safeguard the health and safety of patients," Scully said.

The CMS notice laid out multiple tracks for making national coverage determinations. Under the standard, collaborative process, the agency will strive to implement a coverage decision within 270 days. Beneficiaries in need of a product or service can request an expedited review that would be completed in 90 days. But that streamlined review will limit input from other parties in order to stay within the specified time frame.