Senate bill seeks to reform Medicare’s local coverage determinations

A bill introduced yesterday in the U.S. Senate would reform the way Medicare agencies make local coverage determinations in a bid to make the process more transparent.

The bipartisan bill, S. 794, sponsored by Sen. Johnny Isakson (R-Ga.) and co-sponsored by Sens. Thomas Carper (D-Del.), Debbie Stabenow (D-Mich.) and John Boozman (R-Ark.), would change the way Medicare Administrative Contractors make LCDs for medical devices, according to the Advanced Medical Technology Assn.

It would require MAC meetings to be open to the public and on the record, and mandate disclosure for the reasoning behind a local coverage determination including the evidence backing the decision. The measure would also create an appeals process and bar MACs from adopting LCDs made in other jurisdictions without an independent evaluation, according to AdvaMed.

“Unfortunately, the Local Coverage Determination (LCD) process MACs use is flawed, lacks transparency and does not provide meaningful opportunity for stakeholder input or appeals. As a result, American patients are at risk of being denied access to technologies and services they need,” AdvaMed president & CEO Scott Whitaker said in prepared remarks. “AdvaMed commends Sens. Isakson, Carper, Stabenow and Boozman for their leadership on this issue. This bill builds on provisions to improve the LCD process in the recently passed 21st. Century Cures Act and will foster greater transparency, consistency and objectivity in the process, which will ultimately benefit Medicare beneficiaries. We look forward to working with members of Congress, CMS and other key stakeholders to advance this legislation.”

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