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House of Representatives Passes Transparency Reforms to Medicare LCDs

On September 12, the House of Representatives passed the Local Coverage Determination (LCD) Clarification Act, which aims to improve accountability and transparency in the process Medicare contractors use to make local coverage decisions. Key provisions in the bill include:
  • Open and recorded Medicare Administrative Contractor (MAC) Carrier Advisory Committee meetings
  • Upfront disclosure of evidence MACs consider when drafting an LCD, as well as the rationale they are relying on to deny coverage.
  • Additional options for challenging an LCD
  • Annual reports to Congress on the number of LCD appeals and actions taken in lieu of the creation of an ombudsman.
Read the College of American Pathologists (CAP) press release here.

Posted 9/13/2018