Rep. Lynn Jenkins (R-KS) and Rep. Ron Kind (D-WI) have cosponsored a bill, called the Local Coverage Determination [LCD] Clarification Act of 2016, that would ensure that coverage decisions are made by qualified health experts through a transparent process that is based on sound medical evidence.
“For many procedures, doctors must seek reimbursement permission from one of the 12 local Medicare Administrative Contractors (MACs) that are responsible for designated areas of the country,” said Jenkins. “However, each MAC is independent, meaning that a procedure covered in one state may not be covered in another. This arbitrary care needs to stop…. This legislation will help improve transparency and accountability among MACs and establish a clear process so that only health experts are making expert health decisions.”
According to an MD+DI article the proposed legislation would include several new requirements for the LCD process, including MAC meetings that are open and accessible to the public, rationale and evidence for draft and final LCDs, limitations on MACs adopting other MACs’ LCDs without a separate consideration process, and a process for reconsideration.
