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The federal government should fund and conduct additional research to inform decisions on Medicare coverage for the safest and most effective medical interventions.

Policymakers should improve the quality and quantity of independent research on comparative effectiveness and CEA.

The Centers for Medicare & Medicaid Services (CMS) and local Medicare contractors should continue to make coverage decisions based on standard procedures.

CMS should publicly disclose and seek input regarding any plans for changing the Medicare coverage determination process and the criteria regarding new technologies based on evidence and public inp

Determinations of a drug’s therapeutic or functional equivalence should include appropriate oversight and a provision for medical exceptions (see also this chapter’s sectio

Medicare should monitor research on the validity and effectiveness of at-home tests, even if provided over the counter. 

Medicare should provide adequate reimbursement for mental health and substance abuse services and improve coverage and benefits.

Appeals procedures should be as simple as possible without compromising beneficiary protections.

Health plans should have a process to file grievances about furnished services for which the beneficiary has no further payment liability (e.g., physician behavior, waiting times, and quality of ca