publication date: Nov. 14, 2014

CMS Inserts Unprecedented Conditions Into Medicare Coverage of Lung Screening

CT screening of the lungs of current and former heavy smokers is about to become a Medicare benefit.

A proposed decision published Nov. 10 has inserted some unprecedented conditions into its decision to cover screening:

Beneficiaries would have to go through counseling, and health professionals would be required to provide documentation that “shared decision-making” took place. The Centers for Medicare and Medicaid Services has never mandated shared decision-making as a gateway to paying for a service.

For providers, this means meeting eligibility criteria, providing services that meet technical specifications set by the government, and collecting data and submitting it to a national registry that would be approved by CMS.

The agency’s challenge was to put together a payment policy that would take the results of a clinical trial conducted primarily in the academic setting and apply them in the community, where standards of care may be different.

“It sets a useful precedent for cautious translation of results that were derived from academic centers or experienced centers out into the community,” said Barnett Kramer, director of the NCI Division of Cancer Prevention, who took part in designing and running the National Lung Screening Trial, which provides basis for screening.

“CMS has set an appropriately high bar, because I do think that screening tests in general involve enough complicated decision-making that we … Continue reading 40-43 CMS Inserts Unprecedented Conditions Into Medicare Coverage of Lung Screening

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