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CMS Announces Updates to Local Coverage Determination (LCD) Process to Increase Transparency

This week, CMS released updated guidance on the LCD process aimed at increasing transparency for providers and the public. These changes were required by the ASCRS-supported 21st Century Cures Act of 2016. Specifically, CMS has made the following changes:

  • Modified the process for developing new LCDs that requires Medicare Administrative Contractors (MACs) to consider any complete LCD request submitted by beneficiaries, providers, or other interested parties in the area covered by the MAC, or to provide feedback to the submitter if the request did not include all the required information.
  • MACs must supplement their research for each LCD with clinical guidelines, consensus documents, or consultation by experts (recognized authorities in the field), medical associations or other healthcare professionals for advisory opinions.
  • New or revised LCDs must be posted to CMS’ Medicare Coverage Database at least 45 calendar days before implementation for public comment. MACs are required to respond to comments.
  • MACs must make their Contractor Advisory Committee meetings open to the public.
  • Reforms the LCD reconsideration process.

ASCRS and the Alliance of Specialty Medicine supported the 21st Century Cures Act and have advocated for additional reforms to the LCD process. We will keep you updated.

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