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CMS In Brief

This article was originally published in The Gray Sheet

Executive Summary

More coverage with evidence development?: Coverage with evidence development, in which Medicare covers services or devices only through clinical trials or data registries, has been "indeed successful," said Barry Straube, director and chief clinical officer of CMS' Office of Clinical Standards and Quality, at the AdvaMed 2009 conference in Washington, D.C., Oct. 13. The coverage approach has been most successful in PET scanning, where "we've found we're getting evidence that PET scanning is reasonable and necessary for a number of cancers, and we've added full coverage in those areas," Straube said. "I think this is something we haven't fully utilized and will be utilizing more.

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What Ails Coverage With Evidence Development? MedPAC Discusses Issues

The Medicare Payment Advisory Committee has begun exploring whether CMS needs more help in fostering its coverage-with-evidence-development program

What Ails Coverage With Evidence Development? MedPAC Discusses Issues

The Medicare Payment Advisory Committee has begun exploring whether CMS needs more help in fostering its coverage-with-evidence-development program

Medicare News In Brief

MedPAC addresses CED program: Members of the Medicare Payment Advisory Commission called for greater clarity on CMS' statutory authority to make coverage-with-evidence-development decisions as part of national coverage policies. The advisory group also wants to see more stable and consistent sources of funding for the program. MedPAC analyst Nancy Ray updated the commission on the Medicare agency's use of CED during a Nov. 5 meeting in Washington, D.C. Ray noted that challenges in obtaining public and private funding for clinical trials and patient registries have caused delays in gathering evidence to meet the requirements of the conditional coverage decisions. She added that having a clearer statutory foundation might enable the agency to better develop a formal mechanism to identify and select services for CED and to better articulate standards for collecting CED data. Besides an August national coverage determination for genetic warfarin response screening that included a CED component, CMS has made little use of the tool in the past few years. CMS officials have stated that they believe the CED program is underutilized (1"The Gray Sheet" Oct. 19, 2009)

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