AHA comments on CMS’ proposed revision to definition of ‘reasonable and necessary’ for purposes of Medicare coverage determinations

The AHA today provided comments on the Centers for Medicare & Medicaid Services’ proposed revision to the definition of “reasonable and necessary” for purposes of Medicare coverage determinations.

AHA commented on CMS’ proposed codification of a definition of reasonable and necessary in the Code of Federal Regulations, as well as on the proposed modifications and alternatives to the definition itself.

The AHA in particular expressed concern with a proposal to consider coverage in the commercial health insurance market when making Medicare coverage determinations. In its comments, AHA noted that such an approach could contract coverage in the Medicare program, as well as reduce transparency in coverage determinations. The AHA urged the agency to not move forward with this proposal.