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CMS Announces ASCRS and Alliance of Specialty Medicine-Supported Modifications to Local Coverage Determination Process, Seeks to Provide Accelerated Access to Innovative Treatments

This week, CMS announced it is making modifications to the Local Coverage Determination (LCD) process as a means of ensuring Medicare beneficiaries have accelerated access to innovative drugs and devices. ASCRS and the Alliance of Specialty Medicine called for changes to the LCD process during this year’s Legislative Fly-In and supported a bill recently passed by the House of Representatives that would have required CMS to make these changes. Specifically, CMS is requiring consistent, standardized summaries of the clinical evidence supporting LCD decisions; requiring that Contractor Advisory Committees (CACs) that develop LCDS include a beneficiary representative and other healthcare professionals in addition to physicians, such as nurses or social workers; and requiring that CAC meetings be open to the public. In addition, CMS will allow patients to request a new LCD, and require CACs to hold open meetings virtually, such as by webinar, instead of in-person to allow for broader participation. We will keep you updated.