CLN Article

Bill Could Improve Medicare Coverage Decisions

Federal Insider: August 2017

AACC is endorsing legislation that would make Medicare’s local coverage determination (LCD) process more transparent and increase dialogue between the agency and medical professionals. The bill, the Local Coverage Determination Clarification Act of 2017, is sponsored by Sen. Johnny Isakson, R-Ga., and builds on previous efforts to pass similar legislation in the House of Representatives in 2016.

Under law, Medicare covers medical services that are “reasonable and necessary.” However it is often left to local Medicare administrative contractors (MAC) to decide exactly which tests, procedures, and other services meet that criteria for reimbursement.

In a letter to Sen. Isakson, AACC noted that currently, MACs make these coverage decisions with limited public input or scrutiny, and the legislation is needed to encourage greater interaction and collaboration between MACs and stakeholders. AACC believes that the bill would lead to “better, more consistent policy decisions.”

The bill would require MACs to publish proposed LCDs online and provide an opportunity for public comment, describe the rationale for and evidence supporting the draft policy, and publicly respond to comments when finalizing an LCD decision. The legislation would also limit the ability of MACs to cut and paste policies developed by other contractors without first independently evaluating the evidence underlying the policy and its effect on the region covered by the MAC.