Medicare's National Coverage Decisions For Technologies, 1999-2007

• Published in: Health Affairs Vol. 27; no. 6; pp. 1620 - 1631
• Main Authors: Neumann, Peter J, Kamae, Maki S, Palmer, Jennifer A
• Format: Journal Article
• Language: English
• Published: United States Health Affairs 01.11.2008; The People to People Health Foundation, Inc., Project HOPE
• Subjects: Beneficiaries; Data collection; Decision Making; Decisions; Enactment; Evidence-based medicine; Government programs; Health policy; Insurance Claim Review; Insurance coverage; Insurance Coverage - organization & administration; Medicaid; Medicaid program; Medical Laboratory Science - economics; Medical service; Medical technology; Medicare; Memoranda; Modernization; Organizational Policy; Studies; Technology; Trends; United States; United States; United States > US
• ISSN: 0278-2715; 2694-233X; 1544-5208; 2694-233X
• DOI: 10.1377/hlthaff.27.6.1620

An analysis of Medicare national coverage decisions (NCDs) from 1999 through 2007 reveals that the Centers for Medicare and Medicaid Services (CMS) considers the available evidence as no better than fair for most of the technologies considered. Still, the CMS issues favorable decisions in 60 percent of the cases it takes on, although almost always with conditions placed on coverage. Since enactment of the 2003 Medicare Modernization Act, which legislated maximum review times for NCDs, the CMS has eliminated "long duration" decisions (more than one year) and has issued several "coverage with evidence development" decisions, which promise flexibility but also carry implementation challenges.