NCDs not based on cost-benefit assessment

In a final guidance on national coverage determinations (NCDs) under Medicare Part B, the agency addressed concerns that CMS is establishing a cost-benefit assessment scheme. According to the document, the cost of a "technology is not relevant in the determination of whether the technology improves health outcomes or should be covered for the Medicare population through an NCD."

The guidance also explains factors the agency will consider when starting a national coverage determination (NCD). NCDs may be generated when there are questions about the health benefits of currently covered products or services, when new evidence indicates coverage changes may be warranted, or if "local coverage policies are inconsistent or conflict with each other to the detriment of Medicare beneficiaries." In the absence of an NCD, which sets a national standard for coverage, local Medicare carriers may determine their own coverage policies. An NCD also may be considered for a new item or service, an existing item or service that has been substantially modified, or for a proposed new use of a covered product. ...