Posts Tagged ‘NCA’

The Centers for Medicare & Medicaid Services (CMS) has initiated a national coverage analysis (NCA) for the use of allogeneic hematopoietic stem cell transplantation (HSCT) for Medicare patients with myelodysplastic syndrome (MDS).

MDS refers to a heterogeneous group of acquired bone marrow disorders characterized by dysplastic growth of hematopoietic progenitors and a hypercellular bone marrow with peripheral cytopenia. Medicare patients age 65 and older represent 80 percent of the total population receiving an MDS diagnosis. One potential therapy for MDS is allogeneic HSCT.

This analysis is in response to an NCA request letter industry stakeholders composed and sent to CMS.

Currently, allogeneic HSCT for MDS is neither a covered or non-covered indication under the national coverage determination (NCD) for Stem Cell Transplantation (110.8.1). As it is not in either of these two categories, it may be covered at local contractor discretion. National Government Services (NGS), jurisdiction 13 Part A/Part B Medicare Administrative Contractor (A/B MAC), recently developed a local coverage determination (LCD) for stem cell transplantation that includes MDS and myelofibrosis with myeloid metaplasia.

CMS is seeking public comment on this topic and says it is particularly interested in any additional recent clinical studies and other scientific information related to the outcomes of this treatment. “If the evidence is determined to be inadequate for coverage, we are especially interested in what types of studies are needed,” CMS states in the tracking sheet.

Public comment may be submitted until Dec. 10. The proposed decision memo is due out May 10, 2010 and the NCA is expected to be completed by Aug. 8, 2010.

Outpatient intravenous insulin therapy (OIVIT) is to remain nationally noncovered. The Centers for Medicare & Medicaid Services (CMS) recently concluded that OIVIT does not improve health outcomes and is not reasonable and necessary for any indication. Read more »

The Centers for Medicare & Medicaid Services (CMS) recently updated its Medicare benefit and claims processing policies to reflect National Coverage Determinations (NCD) for noncoverage of certain surgical never events.

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In a May 11 decision memo for screening computed tomography colonography (CTC) for colorectal cancer, the Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is inadequate to conclude that CTC is an appropriate colorectal cancer screening test and it remains noncovered.

Medical News Today has more on the story.

The Medicare Evidence Development and Coverage Advisory Committee (MedCAC) came together May 6 to discuss whether genetic testing improves health outcomes enough to warrant Medicare coverage. Does screening genetic testing change the natural history and/or reduce the complications of the disease and alter morbidity/mortality? The Centers for Medicare & Medicaid Services (CMS) wants to know.

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