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New Medical Services and New Technologies

New Technology Town Hall Meeting Information

The annual New Technology Town Hall meeting will be held on Tuesday, February 3, 2015 at CMS in Baltimore. Complete details on the Town Hall meeting can be found in the Federal Register notice published on November 21, 2014. Click the link below "FY 2016 New Technology Town Hall Federal Register Notice."

  • To register to attend the New Technology Town Hall meeting, click on the link below in the Related Links section titled “Register to Attend the New Technology Town Hall Meeting”
  • Beginning January 19, 2015, photo IDs (such as a driver’s license) issued by a state or territory not in compliance with the Real ID Act will not be accepted as identification to enter Federal buildings.  As of October 27, 2014, the following states/territories are not compliant with the Real ID Act:  American Samoa, Arizona, Louisiana, Maine, Minnesota, New York, Oklahoma, and Washington.  This means CMS visitors from these states/territories will need to provide alternative proof of identification (such as a passport) to gain entrance into CMS buildings.
  • For participants who cannot attend the Town Hall Meeting in person, an open toll-free phone line, (877) 267–1577, has been made available. The meeting number is "993 601 192."
  • To view a live video/audio stream feed of the new technology town hall meeting, visit http://cms.gov/live
  • To participate via webinar, visit http://webinar.cms.hhs.gov/newtech Note: Users can follow presenters slides via the webinar only. Use the call in number for an audio feed or the link above for a live video feed.
  • Users will be able to watch an archived copy of the video/audio stream of the town hall on the CMS You Tube channel at http://www.youtube.com/user/CMSHHSgov/videos?flow=grid&view=2
  • Disclaimer: We cannot guarantee reliability for live streaming technology and/or a webinar.

Application Information for FY 2016

-The deadline to submit (and for CMS to receive) an application for FY 2016 new technology add-on payments was Friday November 21, 2014.

-Tracking forms for applications received have been posted below in the “Downloads” section. Click on the link below “FY 2016 New Technology Tracking Forms”.

BACKGROUND

Sections 1886(d)(5)(K) and (L) of the Act establish a process of identifying and ensuring adequate payment for new medical services and technologies under the IPPS. Section 1886(d)(5)(K)(ii)(I) of the Act specifies that the process must apply to a new medical service or technology if, "based on the estimated costs incurred with respect to discharges involving such service or technology, the DRG prospective payment rate otherwise applicable to such discharges under this subsection is inadequate." Section 1886(d)(5)(K)(vi) of the Act specifies that a medical service or technology will be considered "new" if it meets criteria established by the Secretary after notice and opportunity for public comment.

Section 412.87(b)(3) provides that, to receive special payment treatment, new technologies meeting this clinical definition must be demonstrated to be inadequately paid otherwise under the DRG system. For applicants for new technology add-on payments for FY 2005 and forward, we established the criteria that will be applied to assess whether technologies would be inadequately paid under the DRGs the lesser of 75 percent of the standardized amount increased to reflect the difference between costs and charges (based on the national case weighted cost-to-charge ratio) or 75 percent of 1 standard deviation (based on the logarithmic values of the charges and transformed back to charges) beyond the geometric mean standardized charge for all cases in the DRGs to which the new technology is assigned (or the case weighted average of all relevant DRGs, if the new technology occurs in many different DRGs).

In order to qualify for the new technology add-on payments, a specific technology must be "new" under the requirements of §412.87(b)(2) of our regulations. The statutory provision contemplated the special payment treatment for new technologies until such time as data are available to reflect the cost of the technology in the DRG weights through recalibration (no less than 2 years and no more than 3 years).

Section 412.87(b)(1) of our existing regulations provides that a new technology will be an appropriate candidate for an additional payment when it represents an advance in medical technology that substantially improves, relative to technologies previously available, the diagnosis or treatment of Medicare beneficiaries (see the September 7, 200l final rule (66 FR 46902)). Applicants for FY 2010 must submit a formal request, including a full description of the clinical applications of the technology and the results of any clinical evaluations demonstrating that the new technology represents a substantial clinical improvement, along with data to demonstrate the technology meets the high cost threshold.

The new technology add-on payment policy provides additional payments for cases with high costs involving eligible new technologies while preserving some of the incentives under the average-based payment system. The payment mechanism is based on the cost to hospitals for the new technology. Under §412.88, Medicare pays a marginal cost factor of 50 percent for the costs of the new technology in excess of the full DRG payment. If the actual costs of a new technology case exceed the DRG payment by more than the estimated costs of the new technology, Medicare payment is limited to the DRG payment plus 50 percent of the estimated costs of the new technology.

For a more complete reading on Add-On Payments for New Services and Technologies, please view the Inpatient Prospective Payment System (IPPS) final rule published on August 18, 2008. The final rule and all other regulations and notices are located in the left navigational area of this page.