The article deals with the effort to introduce automatic payment of new medical technologies from the Medicare program in the USA, similar to the so-called "breakthrough" medical devices. It describes the previous Medicare Coverage of Innovative Technology (MCIT) rule, which was supposed to provide national reimbursement for "breakthrough" devices for four years after FDA approval, but was later rescinded. It states that the newer approach is called Transitional Coverage for Emerging Technologies (TCET) and is intended to create a structured transitional framework for reimbursement for emerging technologies. The article explains that automatic or accelerated reimbursement is motivated by an effort to make innovative technologies more quickly available to Medicare patients. He also points out that reimbursement decisions have traditionally been based on evidence of clinical effectiveness and whether the procedure is "reasonable and necessary" for Medicare patients. The text points to the tension between rapid access to innovation and the requirement of a sufficient evidence base even before the introduction of blanket funding. The article describes that the discussion about automatic payment of new technologies returns repeatedly and is the subject of regulatory adjustments and political decisions.