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The MEDCAC ruling will likely lead to non-coverage of lung cancer screening with low dose CT scans for Medicare and Medicaid beneficiaries.
the Medicare Evidence Development & Coverage Advisory Committee
The ruling of (MEDCAC) is both disappointing and discouraging. Its ruling, which will likely lead to non-coverage of lung cancer screening with low dose CT scans for Medicare and Medicaid beneficiaries, will inhibit our ability to make a dent in reducing the negative impact of the number 1 cancer killer in the US, and will have unattended health disparity consequences.
In regards to health disparity, under rules of the Patient Protection Affordable Care Act (ACA), private insurers are required to cover effective prevention measures graded A or B by the US Preventative Services Task Force (USPSTF) as part of an Essential Health Benefit. The USPSTF gave lung cancer screening for high risk patients with low dose CT a grade B. Therefore, under the rules of the ACA, private insurers will be required to cover patients aged 55-64. Centers for Medicare and Medicaid (CMS) beneficiaries without private insurance will not be able to obtain the same benefits of lung cancer screening.
I do understand the worries of MEDCAC, specifically:
I believe an alternative final ruling should approve CMS coverage of lung cancer screening with low dose CT with the following caveats that would address the committees concerns: