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
A new report from KFF reveals that Medicare Advantage enrollees had access to just 48% of the physicians available to Traditional Medicare beneficiaries in…
Headline
The AHA Oct. 23 recommended changes to the Centers for Medicare & Medicaid Services’ Wasteful and Inappropriate Services Reduction model to address…
Headline
The Centers for Medicare & Medicaid Services has released an operational guide for Medicare-enrolled providers and suppliers on the Wasteful and…
Headline
A report by the Department of Health and Human Services Office of the Inspector General found that many Medicare Advantage and Medicaid managed care plans…
Headline
Medicare open enrollment for 2026 began Oct. 15 and runs through Dec. 7. During the annual enrollment period, Medicare-eligible individuals can check their…
Headline
The AHA Oct. 3 responded to the Medicare Payment Advisory Commission’s recent analysis on the financial impacts of Medicare Advantage enrollment growth on…