CMS Establishes Process for Medicare Beneficiaries to Influence Coverage Decisions
The Centers for Medicare & Medicaid Services (CMS) has established a process for individuals to request national coverage determinations (NCDs) for specific medical items, services, or treatments. This process ensures that Medicare beneficiaries have a say in how the CMS decides what to cover.
Individuals can submit electronic NCD requests to [email protected] or via mail to the CMS's Coverage and Analysis Group in Baltimore, Maryland. The CMS considers these requests, which must provide detailed information and evidence, to determine if the item, service, or treatment is reasonable and medically necessary for diagnosing or treating a condition.
The CMS creates NCD policies applicable to all states, while Medicare administrative contractors (MACs) design local coverage determinations (LCDs) when NCD policies are unavailable. These policies help Medicare administrative contractors process claims from medical professionals and facilities. The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC), consisting of 100 healthcare experts, provides independent clinical guidance for coverage decisions to the CMS.
In 2022, the CMS Administrator, Chiquita Brooks-LaSure, led the CMS in shaping health policy and decisions, including NCDs. The CMS continues to welcome input from beneficiaries and healthcare experts to ensure that Medicare coverage aligns with the needs of those it serves.
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