“Millions of Medicare beneficiaries rely on Medicare Administrative Contractors (MACs) to make decisions to ensure they have access to the technologies, procedures and services they depend on.
“Unfortunately, the Local Coverage Determination (LCD) process MACs use is flawed, lacks transparency and does not provide meaningful opportunity for stakeholder input or appeals. Because of these shortcomings, American patients are at risk for being denied access to needed technologies and services.
“The Local Coverage Determination Clarification Act of 2016 introduced by Sens. Thomas Carper (D-Del.) and Johnny Isakson (R-Ga.) will address this issue by improving the transparency and accountability of the LCD process performed by MACs.
“Specifically, the legislation would:
- Require open and public MAC meetings that are on the record
- Require disclosure by MACs of the rationale for an LCD and the evidence for that decision at the beginning of the LCD process
- Provide stakeholders with a meaningful reconsideration process for an LCD
- Prohibit MACs from adopting an LCD from another jurisdiction without first conducting its own independent evaluation of the evidence.