Agencies disagree on uniform medicare coverage policy. (Local or National?).

BALTIMORE -- Federal agencies disagree about whether Medicare should continue to have two types of coverage policies: local coverage decisions that affect only a certain geographic area, and national coverage decisions that affect beneficiaries nationwide.

Representatives of the Centers for Medicare and Medicaid Services tout the value of having two types of decisions.

"If your {scientific] evidence is not mature, it's better to go local," said Dr. Stephen Phurrough of CMS' Office of Clinical Standards and Quality said at a meeting sponsored by the Advanced Medical Technology Association (AdvaMed). But at the national office, we want mature evidence that's fairly consistent." If there's a lot of confusion among various regional Medicare carriers about the value of a device or whether it should be covered, it may be better to seek a national coverage decision to settle the issue, he noted.

Local coverage decisions were necessary because they enhance flexibility, said Dr. Charlotte Yeh, CMS regional administrator for Region I, based in Boston. For instance, state laws and regulations differ; oxygen is considered a drug in some states and not in others, and so it is regulated--and paid for-differently.

In addition, "in the Northeast we have major clinical centers, and sometimes new technology is used in our region when it's not available in the rest of the country," she said. One example would be if a medical center offered a treatment for a rare disease, such as primary amyloidosis. The high rate of treatment for that disease might warrant a local coverage policy.

The U.S. General Accounting Office (GAO) disagrees, and in May it issued a report concluding that the local coverage process should be abolished.

"Because contractors can determine coverage for beneficiaries being treated in their jurisdictions, coverage inequities for beneficiaries with similar medical conditions have resulted," the report noted. "For example, ...