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Re: [IP] Medicare and CGM Coverage



Hi Pam,

 Thank you so much for your thoughtful comments. NHIC Corp. is based in Boston.
They are the Medicare DME administrative contractor (DMAC) for Jurisdiction A
that includes many northeastern states from Maine down the coast to Maryland.
Policy Article A33614 is the LCD for this jurisdiction. The exact same language,
'non coverage because CGM is PRECAUTIONARY' is used throughout the country. Does
anybody believe that this was a coincidence?

 I heard today from the National Manager, Government Relations, at JDRF Advocacy
in Washington, DC. Here are his comments:

 "We were heartened to see the recent decision as it's a positive step forward,
but I think it's important to recognize the limitations of this ruling. The
ruling is being appealed by the government and we'll see what comes of that. In
the meantime, if the ruling were to stand, it would only apply to people within
the jurisdiction of the administrative court that heard the patient's claim - it
would not be a blanket change to federal policy. In addition, the ruling only
applies to a particular reasoning for why the claim was denied - there are other
justifications that could be used to deny coverage, which only further
underscores the importance of changing the policy across CMS.

 To that end, we're still working hard on several fronts to change this policy
at CMS. We're directly engaging with CMS and the Department of Health and Human
Services, in addition to collaborating with attorneys such as Debra Parrish, and
as you well know - we're working hard with Congress to pass the Medicare CGM
Access Act. A multi-pronged strategy like this is necessary to get us to the
endpoint we're looking for."

 I will continue to follow this issue. I thank all the Insulin-Pumpers who have
contacted their U.S. senators and Congress people. I believe some real progress
is finally happening.

Jerry Smith
.
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