National Coverage Determinations
Posted on May 11, 2021
As a Medicare health plan, Health New England Medicare Advantage covers all services required by Original Medicare. We only make mid-year benefit changes when Medicare changes its coverage rules. When this happens, Medicare issues a National Coverage Determination (NCD) explaining whether Medicare will pay for an item or service. Below are the recent changes this year:
Screening for Colorectal Cancer – Blood-Based Biomarker Tests – Effective January 19, 2021
The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover a blood-based biomarker test as an appropriate colorectal cancer screening test once every 3 years for Medicare beneficiaries when performed in a Clinical Laboratory Improvement Act (CLIA)-certified laboratory, when ordered by a treating physician. Learn more at https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=299.
Transcatheter Edge-to-Edge Repair (TEER)/Transcatheter Mitral Valve Repair (TMVR)(CAG- 00438R) – Effective January 19, 2021
For clarity, the term Transcatheter Mitral Valve Repair (TMVR) is being replaced with mitral valve Transcatheter Edge-to-Edge Repair (TEER) to more precisely define the treatment addressed
in this proposed NCD, which is applicable to TEER for the treatment of functional mitral regurgitation (MR) and degenerative MR. Learn more at https://www.cms.gov/medicare- coverage-database/details/nca-decision-memo.aspx?NCAId=297.
Notice of Privacy Practices Updated
Health New England has updated its Notice of Privacy Practices, effective January 1, 2021. To read the updated notice, please visit healthnewengland.org/notice-of-privacy-practices.
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