Medicare's Enduring Struggle to Define “Reasonable and Necessary” Care — NEJM

Medicare's Enduring Struggle to Define “Reasonable and Necessary” Care — NEJM
: "No payment may be made . . . for any expenses incurred for items or services, which . . . are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
— Sec. 1862(a) of the Social Security Act
The Medicare program, among its many functions, serves as the country's preeminent organization for the assessment of health technology. Its decisions to cover and pay for medical technology can have profound consequences for patients' access to therapies, physicians' treatment options, and the fiscal well-being of the program."

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