DME MACs to retire LCDs for nutrition

Coverage criteria defaults to national coverage determination
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Tuesday, October 13, 2020

ALEXANDRIA, Va. – The DME MACs will retire their local coverage determinations for parenteral nutrition and enteral nutrition effective Nov. 12, according to the National Home Infusion Association. 

The NHIA commends the move, saying the LCDs for parenteral nutrition and enteral nutrition “cause delays in access to care for Medicare beneficiaries with gastrointestinal disabilities and are administratively burdensome for hospitals, physicians and home infusion pharmacies,” the association stated in a press release. 

Coverage criteria for Medicare beneficiaries needing parenteral nutrition and enteral nutrition will default to the national coverage determination for these therapies. The NCD relies on physicians to determine medical necessity based on the patient’s clinical condition and mirrors how coverage determinations are made in the commercial sector, the NHIA says. 

“For years, NHIA’s Medicare Contractor Advisory Committee has advocated for updates to the antiquated policies that interfere with access to nutritional support for Medicare beneficiaries in the home,” said Bill Noyes, NHIA’s senior vice president of reimbursement policy. “We are pleased the DME MACs are retiring the outdated coverage requirements, and the MCAC stands ready to work with the DME MACs on the implementation of the new policy. 

Most recently in July, the NHIA and the American Society of Parenteral and Enteral Nutrition held an informal meeting with the DME medical directors to discuss proposed changes to the parenteral nutrition LCD, highlighting the outdated coverage criteria.