Originally Published MX May/June 2003
BUSINESS NEWS
Congress Prods CMS Response Time |
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| Senators Rick Santorum (R–PA; top) and Blanche Lincoln (D–AR). |
Medical device companies have long complained that the Centers for Medicare and Medicaid Services (CMS; Bethesda, MD) are slow to process and implement coverage, coding, and payment decisions for new medical technologies. But that could change under legislation introduced in the Senate at the beginning of April.
The Medicare Innovation Responsiveness Act of 2003 (S. 823), calls on CMS to set reasonable deadlines for implementation of national coverage, coding, and payment decisions and to reduce delays in the amount of time it takes Medicare to set adequate payment for new medical technologies in inpatient settings.
"Significant barriers in the form of bureaucratic delays and inadequate reimbursement levels stand in the way of Medicare patients and their physicians accessing new lifesaving and life-improving medical tests and treatments," says Pamela G. Bailey, president of industry association AdvaMed (Washington, DC). "It is imperative that we eliminate these obstacles and provide these patients with the high-quality healthcare they deserve."
The bipartisan bill was introduced by Senators Rick Santorum (R–PA) and Blanche Lincoln (D–AR), with cosponsorship by Senators Hillary Rodham Clinton (D–NY), Norm Coleman (R–MN), James Jeffords (I–VT), and Jon Kyl (R–AZ). In the House, an equivalent bill (H.R. 941) was introduced under the sponsorship of Representative Jim Ramstad (R–MN), with 22 cosponsors.
According to AdvaMed, Medicare patients currently face delays of 15 months to five years in gaining full access to new, FDA-approved medical tests and treatments. The association blames the slowdown on bureaucratic delays in the three separate coverage, coding, and payment decision processes that a technology must confront before getting to patients.
Provisions of the proposed law would require CMS to implement the following reforms.
- Establish a council for technology and innovation to improve the timeliness and coordination of coverage, coding, and payment decisions.
- Direct Medicare to cover routine-care costs associated with all FDA-approved clinical trials.
- Set reasonable deadlines for implementation of national coverage, coding, and payment decisions and maintaining a strong local coverage process as a vital route to patient access.
- Reduce delays of 2–4 years in the amount of time it takes Medicare to set adequate payment for new medical technologies in the inpatient setting.
- Implement reforms (mandated by Congress more than 2 years ago) to reduce delays in the Medicare patient appeals process.
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