National Coverage Determinations*
Posted on September 13, 2017
Health New England Medicare Advantage makes mid-year benefit changes only when Medicare changes its coverage rules. As a Medicare health plan, our Medicare Advantage plan must cover all services covered by Original Medicare.
When Medicare changes its coverage rules, Medicare issues a National Coverage Determination (NCD) explaining whether Medicare will pay for an item or service. Below are the recent changes from the past year to Health New England’s Medicare Advantage health care benefits:
- Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)
Effective May 25, 2017, the Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover supervised exercise therapy (SET) for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease (PAD). Up to 36 sessions over a 12-week period are covered if all of the components of a SET program are met. - Percutaneous Left Atrial Appendage Closure (LAAC)
Effective October 3, 2016, the Centers for Medicare & Medicaid Services (CMS) covers percutaneous LAAC for non-valvular atrial fibrillation (NVAF) through Coverage with Evidence Development (CED) under 1862(a)(1)(E) of the Social Security Act with certain conditions.
All NCDs are effective on the date the decision memorandum is released. The date is posted to the National Coverage Analysis page of the Medicare Coverage Center website at cms.gov/medicare-coverage-database.
You can also find a listing of recent NCDs on our website at healthnewengland.org/medicare/members. If the newly covered service is covered outside of the contract, the covered service may be obtained from any Medicare provider, including out-of-network providers.
*Health New England Medicare Advantage is an HMO Plan with a Medicare contract. Enrollment in Health New England Medicare Advantage depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.
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