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- CAP Calls on Policymakers to Increase Transparency in Medicare Local Coverage Determination
The CAP is urging policymakers to increase transparency in Medicare’s local coverage determination (LCD) processes while maintaining – and increasing – meaningful opportunities for pathologists and other physicians to provide input on the delivery of health care in the communities in which they serve their patients.
On July 18, the House Energy and Commerce Committee’s Subcommittee on Health held a hearing titled “Innovation Saves Lives: Evaluating Medicare Coverage Pathways for Innovative Drugs, Medical Devices, and Technology.” The CAP is providing recommendations to the subcommittee asking for improvements to both the LCD and national coverage determination processes to ensure access to quality care for Medicare beneficiaries, increase transparency in the LCD process, and provide feedback on the definition of “reasonable and necessary” as well as new coverage pathways for breakthrough devices.
Over the past few years, the CAP has sent letters to the Center for Medicare and Medicaid Services (CMS) advocating for regulatory frameworks that enhance patient safety and maintain quality laboratory testing and innovation without creating a significant regulatory burden on laboratories.
- The first comment letter, from October 2022, includes the CAP recommendations to the CMS to improve the LCD process and address the current underutilization of Contractor Advisory Committee members.
- The CAP also provided comments in November 2022 to help ensure appropriate conditional coverage through an effective coverage with evidence development (CED) process.
- Finally, in late 2020 the CAP provided comments to the CMS on the Medicare Coverage of Innovative Technology proposed rule.
The CAP is passionate about improving current coverage processes and ensuring that patients benefit from technological advances in health care.