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Old Fri Aug 3, 2007, 01:30 AM
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CMS Preserves Coverage of ESAs for MDS

On July 30, CMS issued its final National Coverage Decision (NCD) regarding the use of ESAs in treating non-renal (non-kidney) disease. In its proposed decision issued in May, CMS had planned to eliminate all coverage of ESAs for MDS patients. Those arguing against this decision, including the Aplastic Anemia & MDS International Foundation, opposed the proposal on the grounds that the science did not support that decision. At risk was access to ESAs for Medicare beneficiaries as well as for patients whose private health insurers follow CMS policy.

It is important to note that CMS did not say that ESAs must be covered but said only that it was not removing coverage. The final policy allows Medicare contractors "to make reasonable and necessary determinations on all uses of ESAs that are not determined by NCD," including MDS. However, contractors are expected to cover ESAs for MDS.

Complete details of the Decision Memo are available at the CMS website.
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