Heart of Health Policy | CMS Releases Proposed Medicare Coverage Changes For TAVR

Cardiology Magazine Image

The Centers for Medicare and Medicaid Services (CMS) last month released a draft national coverage determination (NCD) governing its TAVR coverage policy for Medicare fee-for-service patients. The proposed coverage includes some familiar elements from the existing NCD that has been in place since 2012, while also taking new approaches to facilitate access to this therapy.

Under the proposed NCD, coverage would be contingent on:

  • Care of the patient by an interdisciplinary heart team that includes a cardiac surgeon and interventional cardiologist
  • Facility infrastructure and volume standards
  • Interventional cardiologist and cardiac surgeon experience and volume standards
  • Joint interventional cardiologist and cardiac surgeon participation in intra-operative technical aspects of the procedure
  • Data collection through a national registry to allow continued study of key research questions through the tracking of procedural and postprocedural outcomes

These coverage criteria incorporate some themes and specifics from the 2018 AATS/ACC/SCAI/STS Expert Consensus Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement. ACC, AATS, SCAI and STS previously commented to CMS that certain criteria to establish and maintain TAVR programs are necessary to optimize quality outcomes and patient safety.

Cardiology Magazine ImageACC President Richard J. Kovacs, MD, FACC

ACC Advocacy staff and member leaders are carefully reviewing the proposed rule and will submit official comments to CMS by the 30-day public comment deadline on April 25. CMS will issue its final NCD by June 24.

"The ACC is pleased to see CMS propose updated TAVR coverage criteria that builds on the existing foundation of successful patient care stemming from the 2012 NCD. The draft NCD creates a path for new sites to develop and demonstrate infrastructure necessary to initiate a program and continue providing high-quality care," said ACC President Richard J. Kovacs, MD, FACC.

Keywords: ACC Publications, Cardiology Magazine, Health Policy, Transcatheter Aortic Valve Replacement, Fee-for-Service Plans, Patient Safety, Centers for Medicare and Medicaid Services, U.S., Consensus, Medicaid, Medicare, Registries, Federal Government, Patient Care, Surgeons

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