AHIP raises concerns over Medicare innovation, 'reasonable and necessary' rule

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America's Health Insurance Plans submitted comments to CMS Administrator Chiquita Brooks-LaSure on Oct. 12 over the organization's Medicare Coverage of Innovative Technology and Definition of "Reasonable and Necessary" rule. 

CMS opened public comment on the final rule, which was published in January but received significant criticism.

In AHIP's comment, the organization raised concerns about the innovative technology rule's pathway process, which it said fails to fully "evaluate safety, efficacy, and value" of technologies. It also cited operational issues, such as when and how CMS should communicate appropriate information with constituents.

AHIP also took issue with the definition of "reasonable and necessary," which it said removes existing flexibilities. The organization encouraged CMS to continue to bring stakeholders to the table as it discusses changes. 

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