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Medicare News In Brief

This article was originally published in The Gray Sheet

Executive Summary

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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