The Health Care Financing Administration today named the remaining members of the Medicare Coverage Advisory Committee, the group of experts who will advise Medicare on coverage policy decisions.
Named today were additional members of the Executive Committee and members of the Diagnostic Imaging Panel, Durable Medical Equipment Panel, and Medical Devices and Prosthetics Panel. These selections complete the membership of the new panels, whose expertise will assist Medicare in making timely, science-based coverage decisions using a new administrative process that is easily understood and open to the public.
On August 5, HCFA named members of the Laboratory and Diagnostic Services Panel, Drugs, Biologics and Therapeutics Panel, and Medical and Surgical Procedures Panel.
"The Executive Committee includes some of the most respected health policy and technology assessment authorities in the United States today," said HCFA Deputy Administrator Michael Hash. "Medicare beneficiaries can be confident that HCFA has access to the latest scientific information."
The coverage committee serves as an advisory body to HCFA on national coverage decisions to ensure Medicare beneficiaries have access to the latest effective, evidence-based treatment. To make national coverage decisions, HCFA, the agency that administers Medicare, relies on medical and scientific evidence including medical literature and data, discussions with medical experts and technology evaluations.
The advisory committee and panels will meet at least twice a year and provide an opportunity for public participation on coverage issues referred to the committee by HCFA. The committee will review and evaluate medical literature, analyze technology assessments, and examine data and information on the effectiveness and appropriateness of medical devices and procedures. Based on the medical evidence reviewed, the committee will advise and make recommendations on Medicare decisions, but HCFA makes final Medicare coverage decisions.
Each of the six advisory panels is organized to roughly parallel Medicare benefit categories, enabling HCFA to obtain the most pertinent technical advice. The panels will be asked to evaluate scientific evidence to assist HCFA in making coverage decisions.
The two-year terms of the panel members are staggered with about one-third expiring in 2001, one-third in 2002 and one-third in 2003. The panel and executive committee meetings and the administrative record of the coverage decision are public.
The Drugs, Biologics and Therapeutics Panel will meet September 16 to develop a recommendation on whether Medicare should cover high dose chemotherapy and bone marrow transplantation for the treatment of multiple myeloma. Each year about 13,000 Americans develop multiple myeloma.
"At this first meeting of one of the new Medicare advisory panels, we officially begin an advisory process that will give HCFA the best scientific information available on which to base our coverage decisions," said Jeffrey Kang, M.D., Director of HCFA's Office of Clinical Standards and Quality.
In an April 27, 1999 Federal Register notice, HCFA described the new administrative process for making national coverage decisions. While building on current procedures, the agency will take additional steps to ensure that the national coverage process is more open, predictable and understandable. The April announcement also outlined how the public may request national coverage decisions, time lines for reviewing requests and the roles of HCFA, the advisory committee and technology assessment in national coverage decisions.
The Medicare law provides for broad coverage of many medical and health care services, including care provided by physicians, hospitals, skilled-nursing facilities and home health agencies. Instead of providing an all-inclusive list of items and services covered by Medicare, Congress gave the Health and Human Services Secretary the authority to decide which specific items and services within these categories can be covered by Medicare.
The law also states that Medicare cannot pay for any items or services that are not "reasonable and necessary" for the diagnosis and treatment of illness and injury. For more than 30 years, the Medicare program has exercised this authority to determine whether specific services that meet one of the broadly defined benefit categories should be covered under the program.
Most Medicare coverage and policy decisions are made locally by HCFA contractors--the private companies that by law process and pay Medicare claims. HCFA also makes coverage policies that apply nationwide and are binding on all contractors and administrative law judges. Under the new administrative process, HCFA will initiate coverage reviews when appropriate and accept formal requests from external parties for coverage decisions. The agency will typically initiate a national coverage review when there are conflicting local contractor coverage policies, a service represents a significant medical advance and no similar service is covered by Medicare, there is substantial disagreement among medical experts about a service's efficacy or medical effectiveness, or the service is currently covered but is widely considered ineffective or obsolete.
Lists of the names and affiliates of the three panels and executive committee announced today are attached.
Thomas V. Holohan, MA, MD, FACP
Chief, Patient Care Services
Veterans
Health Administration
Department of Veterans Affairs
Washington, DC
Leslie P. Francis, JD, PhD
Professor
College of Law-Department of
Philosophy
University of Utah
Salt Lake City, UT
Laboratory and Diagnostic Services Panel
John H. Ferguson,
Director, Office of Medical Applications
Research
National Institutes of Health
Bethesda, MD
Robert L. Murray, PhD
Technical Director, Clinical
Laboratories
Lutheran General Hospital
Park Ridge, IL
Medical and Surgical Procedures Panel
Alan M. Garber, MD, PhD
Professor of Medicine
Stanford University
Medical School
Stanford, CA
Michael D. Maves, MD, MBA
Executive Vice President
American Academy of
Otolaryngology
Head & Neck Surgery
Alexandria, VA
Diagnostic Imaging Panel
David M. Eddy, MD, PhD
Senior Advisor
Health Policy &
Management
Kaiser Permanente Southern California
Washington, DC
Frank
J. Papatheofanis, MD, PhD
Assistant Professor of Radiology
Department of
Radiology
University of California San Diego
San Diego, CA
Medical Devices and Prosthetics Panel
Harold C. Sox, MD
Professor & Chair
Department of
Medicine
Dartmouth-Hitchcock Medical Center
Lebanon, NH
Ronald M. Davis, MD
Director
Center for Health Promotion &
Disease Prevention
Henry Ford Health System
Detroit, MI
Durable Medical Equipment
Daisy Alford-Smith, PhD
Director
Summit County Department of
Health
Akron, OH
Joe W. Johnson, DC
Private chiropractor
Paxton, FL
Member At Large
Robert H. Brook, MD, ScD
Vice President & Director
RAND Health and
Corporate Fellow
The RAND Corporation
Santa Monica, CA
Consumer Representative
Linda A. Berthold, PhD
Consultant and Researcher
Stanford, CA
Industry Representative
Randel E. Richner, MPH
Director
Reimbursement and Outcomes
Planning
Boston Scientific Corporation
Natick, MA
Diagnostic Imaging Panel of the Medicare Coverage Advisory
Committee
David M. Eddy, MD, PhD
Senior Advisor
Health Policy &
Management
Kaiser Permanente Southern California
Washington, DC
Vice-Chairperson
Frank J. Papatheofanis, MD, PhD
Assistant Professor
Department of
Radiology
University of California San Diego
San Diego, CA
Voting Members
Carole R. Flamm, MD, MPH
Senior Consultant
Blue Cross & Blue Shield
Association
Technology Evaluation Center
Chicago, IL
Jeffrey C. Lerner, Ph.D.
Vice President
Strategic
Planning
ECRI
Plymouth Meeting, PA
Michael Manyak, MD
Professor and Chairman
Department of
Urology
George Washington University Medical Center
Washington, DC
Donna Novak, BA
Senior Manager
Deloitte & Touche, LC
Chicago, IL
Manuel D. Cerqueira, MD
Associate Chief
Clinical
Cardiology
Georgetown Hospital University Medical Center
Washington, DC
Kim J. Burcheil, MD
Vice Chair for Hospital Affairs
Department of
Surgery
Oregon Health Sciences University
Portland, OR
Steven Guyton, MD, MPH
Surgeon
Cardiology & Thoracic Surgical
Service
Virginia Mason Medical Center
Seattle, WA
Consumer Representative
Sally Hart, JD
Consulting Attorney
Center for Medicare
Advocacy
Tucson, AZ
Industry Representative
Michael S. Klein, MBA
Senior Vice President
Marketing and
Sales
Varian Oncology Systems
Palo Alto, CA
Durable Medical Equipment Panel of the Medicare Coverage Advisory
Committee
Daisy Alford-Smith, PhD
Director
Summit County Department of
Health
Akron, OH
Vice-Chairperson
Joe W. Johnson, DC
Private Chiropractor
Paxton, FL
Voting Members
Edward A. Eckenhoff, MA, MHA
President & CEO
National
Rehabilitation Hospital
Washington, DC
Halley S. Faust, MD, MPH
President
Medmax Ventures, LC
Bloomfield,
CT
Neil Kahanovitz, MD
Orthopaedic Surgeon
Anderson Orthopaedic
Clinic
Arlington, VA
Lisa Landy, MD
Private Practitioner
Tucson, AZ
Kathleen O'Connor, MA
Executive Director
WHERE
Seattle, WA
Emil Paganini, MD
Section Head
Dialysis & Extracorporeal
Therapy
The Cleveland Clinic Foundation
Cleveland, OH
Antonio Puente, Ph.D.
Professor
Department of Psychology
University
of North Carolina at Wilmington
Wilmington, NC
Mary Margaret Sharp-Pucci, EdD, MPH
Senior Consultant
Blue Cross &
Blue Shield Association
Technology Evaluation Center
Chicago, IL
Michael J. Strauss, MD, MPH
Executive Vice President
Covance
Inc.
Washington, DC
Consumer Representative
Marilyn-Lu Webb, PhD
Director
Manage Incontinence Positively
Fresno,
CA
Industry Representative
Jonathan Weil, JD, PhD
Senior Attorney
Medical Products Group/Federal
Regulations
Hewlett-Packard Co.
Andover, MA
Medical Devices and Prosthetics Panel of the Medicare Coverage
Advisory Committee
Harold C. Sox, MD
Professor & Chair
Department of
Medicine
Dartmouth-Hitchcock Medical Center
Lebanon, NH
Vice-Chairperson Ronald M. Davis, MD
Director
Center
for Health Promotion &
Disease Prevention
Henry Ford Health
System
Detroit, MI
Voting Members
Willarda V. Edwards, MD
Managing Partner, Internal Medicine
Baltimore,
MD
John T. Hinton, DO, MPH
Vice President
Medical Management
Preferred
Physician Partners
Cincinnati, OH
Anne C. Roberts, MD
Professor
Department of Radiology
University of
California at
San Diego Medical Center
Thornton Hospital
La Jolla, CA
Karl A. Matuszweski, MS, PharmD
Director
Technology Assessment
Program
Clinical Practice Advancement Center
University Health System
Consortium
Oak Brook, IL
Thomas E. Strax, MD
Professor & Chairman
Department of Physical
Medicine &
Rehabilitation
University of Medicine &
Dentistry
New Jersey Robert Wood Johnson
Medical School
Edison, NJ
Wade M. Aubry, MD
National Medical Consultant
Health Management Systems
Blue Cross & Blue Shield Association
Technology Evaluation
Program
San Francisco, CA
Consumer Representative
Rory A. Cooper, PhD
Professor & Chairman
Department of
Rehabilitation Science &
Technology
University of
Pittsburgh
Pittsburgh, PA
Industry Representative
Eileen C. Helzner, MD
Vice President
Worldwide Clinical Development
&
Outcomes Research Professional Group
Johnson &
Johnson
Titusville, NJ
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Last Updated September 10, 1999
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