Senators introduce bill to change LCD process

Wednesday, October 5, 2016

WASHINGTON – Two senators recently introduced a bill that seeks to improve the transparency and accountability of the local coverage determination (LCD) process performed by the Medicare Administrative Contractors (MACs).

The Local Coverage Determination Clarification Act of 2016 would: require open and public meetings with the MACs that are on the record; require disclosure by the MACs of the rationale for an LCD and the evidence for that decision at the beginning of the process; provide stakeholders with a meaningful reconsideration process for an LCD; and prohibit the MACs from adopting an LCD from another jurisdiction without first conducting its own independent evaluation.

“Unfortunately, the LCD process MACs use is flawed, lacks transparency and does not provide meaningful opportunity for stakeholder input or appeals,” said Scott Whitaker, president and CEO of the Advanced Medical Technology Association (AdvaMed), in a statement. “Because of these shortcomings, American patients are at risk for being denied access to needed technologies and services.”

AdvaMed is a trade association representing medical device manufacturers. It has nearly 300 member companies, including Cardinal Health, Coloplast, ConvaTec, DJO, Hill-Rom and Philips Health Care.

Sens. Thomas Carper, D-Del., and Johnny Isakson, R-Ga., introduced the bill in late September.

A similar bill was introduced in the House of Representatives in July.