CMS Revises Medicare Manual to Improve Transparency of LCD Process

October 16, 2018

On Oct. 3, 2018, the Centers for Medicare & Medicaid Services released a Fact Sheet summarizing key revisions to Chapter 13 of the Medicare Program Integrity Manual. These revisions, issued in response to the 21st Century Cures Act, aim to improve transparency in the local coverage determination (LCD) process. The manual includes instructions and procedures for Medicare administrative contractors that administer the Medicare program in various regions throughout the country. 

The revised chapter includes a number of significant changes to the LCD process:

  1. A roadmap of the LCD process that is accessible to all stakeholders.
  2. A standardized summary of clinical evidence needed to support LCD decisions and coverage rationales.
  3. An option to request an informal meeting with a Medicare administrative contractor to discuss LCD decisions.
  4. A process allowing interested parties to request a new LCD.
  5. A restructured Contractor Advisory Committee meeting process that includes meetings open to the public. In addition to physicians, other healthcare professionals may participate in the committee.
  6. Retirement of previously proposed LCDs not enacted within one year from the original posting date.
  7. Removal of CPT and ICD-10 codes from policies.
  8. An LCD reconsideration process, required for consistency with the National Coverage Determination Reconsideration process.

A number of additional changes to the LCD process could be implemented if the Local Coverage Determination Act of 2018, which the House of Representatives passed Sept. 12, is signed into law. Please contact one of the authors below with any questions about the content of this Legal Alert.