New York, Alabama, Wyoming Use AHRQ Technology Assessment to Inform Cardiac Coverage Decisions

As a result of AHRQ's Knowledge Transfer Program, several State Medicaid policymakers have used the AHRQ Technology Assessment, Non-Invasive Imaging for Coronary Artery Disease, to help inform coverage decisions in their States. The technology assessment, which examined the scientific evidence on direct non-invasive imaging tests for evaluating coronary artery disease, has proven useful to the Medicaid Medical Directors' Learning Network.

In September 2007, an evidence review conference call was held among the members of the Medicaid Medical Directors' Learning Network to hear from the report's authors and to discuss current practice.

One of the imaging tests examined in the technology assessment is computed tomographic angiography (CTA), a specialized x-ray that examines blood flow in arteries when they are filled with a contrast material. The report concluded that the evidence base for CTA's ability to identify, quantify, or characterize coronary artery disease was limited.

James J. Figge, MD, MBA, Medical Director, Office of Health Insurance Programs, New York State Department of Health, notes that the AHRQ technology assessment was "the single most important item we considered" in making an initial coverage decision for CTA.

Figge states, "We determined there was insufficient evidence to demonstrate that the technology had a well-defined impact on outcomes, so we decided in 2006 not to cover CTA. I thought [the call] was absolutely fantastic, and I think everybody on the call did as well," noting AHRQ's ability to facilitate dialogue among frontline clinicians and national experts well-versed in the current evidence base.

Following the call, other States have considered covering CTA or have decided to cover CTA only for specific conditions.

In Alabama, Robert Moon, MD, Medical Director, Office of Health Policy, Alabama Medicaid Agency, used the report findings to analyze whether the State agency should conduct in-house prior authorizations for CTA or use a prior authorization contractor. As Alabama officials weighed their options, they used the technology assessment findings to support Medicaid's decision not to cover this procedure unless a unique medical justification was supplied.

Moon remarks, "The report was very well done and provided us with the clinical support we needed to communicate our decision with our providers." Alabama Medicaid eventually concluded that they would use a contractor to administer the prior authorization process.

In Wyoming, officials felt that the conference call and AHRQ technology assessment were useful presentations on the current evidence on CTA, keeping them abreast of this controversial area. Wyoming Medicaid policy currently covers CTA without prior authorization.

James Bush, MD, State Medicaid Medical Director, Office of Health Care Financing, Wyoming Department of Health, notes, "Wyoming probably does not have the patient density to make a CTA facility economically worthwhile. There is little demand for the procedure in the State, and there are no facilities performing high resolution CTA."

The AHRQ Technology Assessment was prepared for the Medicare Coverage Advisory Committee by the Duke Evidence-based Practice Center in October 2006.