National Coverage Determinations*

Posted on March 26, 2018

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 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. The list below contains all recent changes from the past year to Health New England’s Medicare Advantage health care benefits:

• Leadless Pacemakers
Effective January 18, 2017, the Centers for Medicare & Medicaid Services (CMS) covers leadless pacemakers through Coverage with Evidence Development (CED). CMS covers leadless pacemakers when procedures are performed in Food and Drug Administration (FDA) approved studies. CMS also       covers, in prospective longitudinal studies, leadless pacemakers that are used in accordance with the FDA approved label for devices that have either an associated ongoing FDA approved post-approval study or completed an FDA post-approval study.

• Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease
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.

All NCDs are effective on the date the decision memorandum is released. The date it is posted to the National Coverage Analysis page of the Medicare Coverage Center website at cms.gov/medicare-coverage-database.

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.

To request printed copies or if you have any questions, please call Member Services at (413) 787-0010 or toll-free at (877) 443-3314 (TTY: 711). Member Services hours are 8 a.m. – 8 p.m., Monday – Friday (Oct. 1 – Feb. 14: 8 a.m. – 8 p.m., seven days a week).

*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.

Categories: MemberMatters - Medicare