Medicare Expansion Outcome

BACK TO MEDICARE EXPANSION HOMEPAGE

CMS PUBLISHES COVERAGE EXPANSION FOR COCHLEAR IMPLANTS UNDER MEDICARE

9/26/2022

On September 26, the Centers for Medicare & Medicaid Services (CMS) published details on its decision to expand coverage for cochlear implants under Medicare. This provides a significant improvement in access to care for older adults who are Medicare beneficiaries allowing individuals with hearing test scores between >40% and ≤60% to qualify for cochlear implantation. After reviewing the evidence submitted as part of the National Coverage Determination (NCD) process, CMS found that the evidence was sufficient to determine that cochlear implantation may be covered for a broader spectrum of hearing loss. The policy change is effective immediately.

Specifically, CI is an appropriate treatment of bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss in individuals who demonstrate limited benefit from amplification defined by test scores of less than or equal to 60% correct in the best-aided listening condition on recorded tests of open-set sentence cognition. Patients must meet other criteria defined by CMS as well. The final decision memorandum for the reconsideration of Cochlear Implantation was published here: https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=306

The change was sought early on by the newly organized American Cochlear Implant Alliance with a multi-center study to explore and document outcomes in older adults who had more residual hearing than was currently allowed under Medicare coverage criteria. We approached the Centers for Medicare and Medicaid Services (CMS), requesting that they partner with us and allow Medicare expanded coverage for individuals who were part of the ACI Alliance study. Principal investigators Terry Zwolan PhD, Craig Buchman MD, and John Niparko MD led the multi-center study effort. Their thoughtful leadership over a sustained timeframe led to this important outcome. Click here for more information on the expansion effort.

Drs. Zwolan and Buchman expressed gratitude to the CI clinicians and patients who participated in the study effort as well as CMS officials involved in the NCD process as they sought to balance care in provision of the CI intervention for older adults with the documented outcomes in communication and overall quality of life.

We will be providing materials for our ACI Alliance members who wish to help publicize this important expansion in access to CI with local media outlets, patients, and others.

CMS PUBLISHES PROPOSED COVERAGE EXPANSION FOR COCHLEAR IMPLANTS UNDER MEDICARE

7/6/2022

Proposed Criteria Expansion

We are pleased to announce that on July 6, the Centers for Medicare & Medicaid Services (CMS) published details on its proposed coverage expansion for cochlear implants. If adopted, Medicare would broaden candidacy criteria to allow individuals with hearing test scores of >40% and ≤60%. After reviewing the evidence submitted as part of the National Coverage Determination (NCD) process, CMS found that the evidence was sufficient to determine that cochlear implantation may be covered for a broader spectrum of hearing loss. Specifically, CI is an appropriate treatment of bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss in individuals who demonstrate limited benefit from amplification defined by test scores of less than or equal to 60% correct in the best-aided listening condition on recorded tests of open-set sentence cognition. Patients must meet other criteria defined by CMS as well.

We approached the Centers for Medicare and Medicaid Services (CMS), requesting that they partner with us and allow Medicare expanded coverage for individuals who were part of the ACI Alliance study. Principal investigators Terry Zwolan PhD, Craig Buchman MD, and John Niparko MD led the multi-center study effort. Click here for more information on the expansion effort:

Decision Summary

The July 6 announcement can be found here.
In addition to the ACI Alliance request with related documentation, CMS conducted its own internal technology assessment. The Decision Summary includes reviews of published studies, a consensus statement, and a professional society guideline. Public comments provided further support for the expansion.

Support the Proposed Decision

American Cochlear Implant Alliance supports the proposed expansion criteria as presented in the July 6 Memo. There is an opportunity for 30 days (due date August 5) to comment. We encourage our members to provide a simple statement acknowledging the thorough work of CMS and supporting the expansion criteria decision as presented. Click here for the comment area.

This is important news for the patient community and the clinicians who serve them! We are appreciative of the work of so many clinicians and researchers who contributed to this positive outcome.

Read more here.

MEDICARE CI EXPANSION SUPPORTED BY HEARING LOSS COMMUNITY

4/5/2022

On April 5, ACI Alliance met with CMS officials responsible for evaluating the NCD and determining how and whether CI candidacy will be changed. We brought with us The Incredible Hulk to share his compelling journey with hearing loss and then, recently receiving a cochlear implant. ACI Alliance will continue to monitor the process and seek the input and involvement of our members and the entire hearing health community as the process moves forward.

Read the full article here.

ACI ALLIANCE ENCOURAGES BROAD COMMUNITY PARTICIPATION IN CI EXPANSION UNDER MEDICARE VIA A NATIONAL COVERAGE DETERMINATION (NCD)

3/28/2022

One of the first initiatives undertaken by the newly organized American Cochlear Implant Alliance was a multi-center study to explore outcomes in older adults with greater speech recognition than is allowed under current Medicare criteria. We approached CMS requesting that they partner with us and allow Medicare expanded coverage for individuals who were part of the ACI Alliance study. Principal investigators Terry Zwolan PhD, Craig Buchman MD, and John Niparko MD led the study effort. Historical discussion of what was done is on the ACI Alliance website.

The study assessed outcomes in Medicare beneficiaries with scores that fell between 40 and 60% correct on AzBio sentences in the best aided condition when stimuli were presented in quiet at 60 dBA. Study results were published in JAMA Otolaryngology in October 2020 “Assessment of Cochlear Implants for Adult Medicare Beneficiaries Aged 65 Years or Older Who Meet Expanded Indications of Open-Set Sentence Recognition” by Zwolan et al.

The favorable study results helped us in our effort to formally request a reconsideration of criteria under a formal process through CMS called a National Coverage Determination (NCD). The NCD opened for public comment for 30 days on March 1, 2022.

Read ACI Alliance Comments Here.

Read the Comments from NCD Study PIs Drs. Terry Zwolan and Craig Buchman here.

Read the full story here.