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Focus on Regulation

CMS Issues New Notice on Its National Coverage Determination Process

CMS has issued a notice announcing updates to the process it uses for opening, deciding, or reconsidering national coverage determinations (NCDs).  The notice provides further guidance on external requests and internal review for new or reconsidered NCDs. 

Perhaps the most novel aspect of the notice is a new “expedited administrative process” to remove certain NCDs, which would leave coverage determinations on the topic to the discretion of Medicare contractors.  This process would impact NCDs that have not been reviewed for at least 10 years, and CMS would assess the continued need to have a national coverage policy on the topic.  Under the process, CMS will publish a list of the NCDs it proposes to remove and accept public comments on the proposals before making a final decision.

This issuance by CMS is a notice that will be effective as of the date it is published in the Federal Register, which is expected to be August 7, 2013.  CMS has not solicited comments on the provisions contained in the notice.