{"id":5142,"date":"2019-05-07T17:37:39","date_gmt":"2019-05-07T22:37:39","guid":{"rendered":"https:\/\/www.appliedpolicy.com\/staging\/7403\/?p=5142"},"modified":"2019-05-07T17:39:50","modified_gmt":"2019-05-07T22:39:50","slug":"verma-announces-plan-to-foster-innovation-for-transformative-medical-technologies","status":"publish","type":"post","link":"https:\/\/www.appliedpolicy.com\/staging\/7403\/verma-announces-plan-to-foster-innovation-for-transformative-medical-technologies\/","title":{"rendered":"Verma Announces Plan to Foster Innovation for Transformative Medical Technologies"},"content":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row&#8221; gap=&#8221;35&#8243;][vc_column][vc_column_text]On May 2, CMS Administrator Seema Verma announced the Trump Administration\u2019s \u201ccomprehensive strategy\u201d to foster innovation for and improve patient\u2019s access to transformative medical technologies. The strategy, detailed by Administrator Verma in a speech at the <a href=\"https:\/\/medicaldevices.site-ym.com\/default.aspx\">Medical Device Manufacturers Association (MDMA)<\/a> Annual Meeting, is based on two specific changes related to coding. CMS says that these two actions \u201crepresent key components of a comprehensive CMS strategy to address barriers to medical innovation in the Medicare program.\u201d<\/p>\n<p>First, under the Healthcare Common Procedure Coding System (HCPCS), CMS is expanding opportunities for manufacturers to apply for Level II codes, which had stood at one per year. For drugs that are usually not self-administered, CMS will award J-codes on a quarterly basis, and for devices, they will award new codes semiannually. CMS said it \u201canticipates this will greatly improve the ability for technologies to move through the adoption curve\u201d and noted that the Agency will provide continuing updates to the process.<\/p>\n<p>Second, for technologies with <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/category-iii-codes\">Category III CPT<sup>\u00ae<\/sup> codes awarded by the American Medical Association<\/a> (sometimes referred to as T-codes) and used for emerging technologies that do not fall under an existing Local Coverage Determination (LCD), Medicare contractors are required to follow the new LCD\u00a0 process and cannot base a determination not to cover the device on its T-code.\u00a0 This clarification was included in a list of answers to commonly asked questions about the Local Coverage Determination process that the agency posted just prior to Administrator Verma\u2019s address.<\/p>\n<p>CMS seems to be taking a more technology-friendly approach than many commercial insurers and Medicare Advantage plans are taking.\u00a0 For example, <a href=\"https:\/\/www.uhcprovider.com\/content\/dam\/provider\/docs\/public\/policies\/medadv-guidelines\/c\/category-iii-cpt-codes.pdf\">UnitedHealthcare<\/a> has a policy in place that says, \u201cbecause of the specific purpose these Category III codes serve, UnitedHealthcare will consider the item, service, or procedure represented by these codes to be not proven effective; therefore, the codes will be denied as not medically necessary, unless an LCD or coverage article specifically extending coverage to a particular Category III code has been published.\u201d\u00a0\u00a0 CMS was not clear as to whether it would continue to approve Medicare Advantage plans that included policies like these.<\/p>\n<p>The Agency recently proposed also to provide a path for breakthrough devices approved by the FDA to receive add-on payments in the fiscal year 2020 Inpatient Prospective Payment System (IPPS) rule. As I stated in an interview with <a href=\"https:\/\/insidehealthpolicy.com\/daily-news\/verma-lays-out-changes-hcpcs-coding-process-clarifies-device-lcds\">Inside Health Policy,<\/a> it remains to be seen how helpful these changes will be in practice as CMS&#8217; releases further guidance and stakeholders work through the updated process. The test will be whether new technology is covered and gets to beneficiaries faster.<\/p>\n<p>Additionally, CMS cited recent proposed changes to the hospital inpatient payment rule,\u00a0 specifically noting its intent to increase the new technology add-on payment (NTAP) which provides hospitals with additional payments for cases with high costs involving new technology. CMS also noted that it is proposing to modernize payment policies for medical devices that meet FDA\u2019s Breakthrough Devices designation. The agency says its overall strategy \u201cwill help ensure predictable coverage pathways, enhance opportunities for coverage for transformative technologies, reduce wait times to apply for permanent codes, and modernize payment for innovative services.\u201d<\/p>\n<p>&nbsp;<\/p>\n<p>Administrator Verma\u2019s speech can be viewed at:\u00a0<u><a href=\"https:\/\/www.cms.gov\/newsroom\/press-releases\/speech-remarks-administrator-seema-verma-medical-device-manufacturers-association\">https:\/\/www.cms.gov\/newsroom\/press-releases\/speech-remarks-administrator-seema-verma-medical-device-manufacturers-association<\/a><\/u>.<\/p>\n<p>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row&#8221; gap=&#8221;35&#8243;][vc_column][vc_column_text]On May 2, CMS Administrator Seema Verma announced the Trump Administration\u2019s \u201ccomprehensive strategy\u201d to foster innovation for and improve patient\u2019s access to transformative medical technologies. The strategy, detailed by Administrator Verma in a speech at the Medical Device Manufacturers Association (MDMA) Annual Meeting, is based on two specific changes related to coding. CMS [&hellip;]<\/p>\n","protected":false},"author":10,"featured_media":5143,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","ap4_related_services":"","footnotes":""},"categories":[436],"tags":[60,317,221,161,67,162],"class_list":["post-5142","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthcare-policy-development","tag-cms","tag-drug-payment","tag-hcpcs","tag-health-policy","tag-medical-devices","tag-reimbursement-policy"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Verma Announces Plan to Foster Innovation for Transformative Medical Technologies - Applied Policy<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/appliedpolicy.com\/verma-announces-plan-to-foster-innovation-for-transformative-medical-technologies\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Verma Announces Plan to Foster Innovation for Transformative Medical Technologies - Applied Policy\" \/>\n<meta property=\"og:description\" content=\"[vc_row full_width=&#8221;stretch_row&#8221; gap=&#8221;35&#8243;][vc_column][vc_column_text]On May 2, CMS Administrator Seema Verma announced the Trump Administration\u2019s \u201ccomprehensive strategy\u201d to foster innovation for and improve patient\u2019s access to transformative medical technologies. The strategy, detailed by Administrator Verma in a speech at the Medical Device Manufacturers Association (MDMA) Annual Meeting, is based on two specific changes related to coding. CMS [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/appliedpolicy.com\/verma-announces-plan-to-foster-innovation-for-transformative-medical-technologies\/\" \/>\n<meta property=\"og:site_name\" content=\"Applied Policy\" \/>\n<meta property=\"article:published_time\" content=\"2019-05-07T22:37:39+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-05-07T22:39:50+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/appliedpolicy.com\/wp-content\/uploads\/Seema-at-MDMA.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"476\" \/>\n\t<meta property=\"og:image:height\" content=\"570\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Jim Scott\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Jim Scott\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/appliedpolicy.com\\\/verma-announces-plan-to-foster-innovation-for-transformative-medical-technologies\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/appliedpolicy.com\\\/verma-announces-plan-to-foster-innovation-for-transformative-medical-technologies\\\/\"},\"author\":{\"name\":\"Jim Scott\",\"@id\":\"https:\\\/\\\/appliedpolicy.com\\\/#\\\/schema\\\/person\\\/a200caa45751a466fa9e77c10844020b\"},\"headline\":\"Verma Announces Plan to Foster Innovation for Transformative Medical Technologies\",\"datePublished\":\"2019-05-07T22:37:39+00:00\",\"dateModified\":\"2019-05-07T22:39:50+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/appliedpolicy.com\\\/verma-announces-plan-to-foster-innovation-for-transformative-medical-technologies\\\/\"},\"wordCount\":567,\"image\":{\"@id\":\"https:\\\/\\\/appliedpolicy.com\\\/verma-announces-plan-to-foster-innovation-for-transformative-medical-technologies\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.appliedpolicy.com\\\/staging\\\/7403\\\/wp-content\\\/uploads\\\/Seema-at-MDMA.jpg\",\"keywords\":[\"cms\",\"Drug Payment\",\"hcpcs\",\"health policy\",\"Medical Devices\",\"reimbursement policy\"],\"articleSection\":[\"Healthcare Policy Development\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/appliedpolicy.com\\\/verma-announces-plan-to-foster-innovation-for-transformative-medical-technologies\\\/\",\"url\":\"https:\\\/\\\/appliedpolicy.com\\\/verma-announces-plan-to-foster-innovation-for-transformative-medical-technologies\\\/\",\"name\":\"Verma Announces Plan to Foster Innovation for Transformative Medical Technologies - 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