Medicare Modernization Act of 2003: Improving Patient Access to New Medical Technology
The Medicare Modernization Act of 2003 (MMA) will help speed and expand patient access to new technology by eliminating the long bureaucratic delays that limit seniors’ access to many lifesaving and life-improving medical tests and treatments. The landmark reform package contains specific provisions to modernize the Medicare program and provide beneficiaries with higher quality health care, including:
New Screening Benefits
Beginning in 2005, Medicare will cover an initial physical exam for newly enrolled Medicare beneficiaries, which could include potentially lifesaving screenings for breast cancer, cervical cancer, and prostate cancer.
In addition, MMA provides cardiovascular screening tests and diabetes screening tests to at-risk beneficiaries. Early detection and treatment of these deadly and debilitating diseases will not only save lives of Medicare patients, but also reduce health care costs.
Clear Timeframes for Medicare National Coverage Decisions
Medicare patients have often been forced to wait 15 months to five years before gaining access to new, FDA-approved medical tests and treatments. To end these bureaucratic delays, MMA sets statutory deadlines for the Centers for Medicare & Medicaid Services (CMS) to complete and fully implement national coverage decisions: nine months for decisions made internally, and 12 months for decisions that are referred for advice outside the Agency.
Adequate Reimbursement for New Inpatient Medical Technologies
Chronic delays in setting adequate Medicare reimbursement for new technologies in the inpatient setting have restricted hospital adoption of new medical technologies. MMA sets reasonable thresholds for special add-on payments for breakthrough technologies to eliminate disincentives for using new technologies and increase patient access.
Increased Medicare Patient Access to Breakthrough Clinical Trials
In 2005, seniors will enjoy greater access to breakthrough clinical trials when Medicare begins covering the routine patient care costs for Category A medical device trials, designed to treat, diagnose, or monitor immediately life-threatening diseases. Prior to MMA, Medicare only covered the routine patient care costs of a more limited number of medical device trials, while covering nearly all drug trials. This coverage limitation posed a significant barrier to companies and hospitals determining whether to begin a clinical trial for a promising new technology.
Council for Technology and Innovation
MMA created a Council for Technology and Innovation within CMS to help speed patient access to new medical technologies. It will coordinate coverage, coding and payment decisions and serve as a single point of contact for patients, physicians and medical technology innovators in dealings with the Agency.
Congressional Action
Passing MMA was just the first step in ensuring that the 40 million elderly and disabled Americans who rely on Medicare have access to the latest medical advances. Ensuring that CMS implements this historic legislation precisely as Congress intended will be a challenge for the 109th Congress.
-September 30, 2004
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