On July 11, 2016, Reps. Lynn Jenkins (R-Kan.) and Ron Kind (D-Wis.) introduced the Local Coverage Determination Clarification Act (H.R. 5721), with the goal of modifying the LCD process performed by Medicare Administrative Contractors (MACs). Intended to make the LCD process more transparent, the bill would change how individual coverage decisions are made by MACs.
MACs utilize the LCD process to decide reimbursements for medical technologies and services not otherwise covered under CMS national coverage determinations. Twelve MACs throughout the country process Medicare claims, and each has the jurisdiction to determine what technology, services and devices will be covered.
The proposed bill includes provisions for:
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Open and accessible public MAC meetings;
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Providing rationale and evidence for draft and final LCDs within 60 days of publication of a draft LCD;
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Limitations on MACs’ ability to adopt other LCDs from another MAC jurisdiction without an independent consideration process; and
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A meaningful reconsideration process.
The bill has been referred to the House Ways and Means and Energy and Commerce committees, but no Senate companion bill has been introduced. The full text of the bill can be found here.
