On September 20, the CAP made recommendations to improve the Medicare local coverage determination (LCD) process by increasing transparency, broadening stakeholder feedback, and shortening timeframes to ensure Medicare beneficiaries receive the tests and services they need.

In a letter to the Centers for Medicare & Medicaid Services (CMS), the CAP emphasized that Medicare Administrative Contractor (MAC) open public meetings should be an opportunity for all physicians and other stakeholders to identify and address issues related to the scientific evidence, clinical practice, and the needs of patients within the context of a local coverage policy. At CMS’ request, the CAP provided examples of MAC meetings conducted that violated open public meetings policy.

Importantly, the CAP also explained that a reasonable timeframe for completing LCD reconsideration requests is necessary to keep pace with advances in science and to provide Medicare beneficiaries with the tests and services they need. The CAP recommended that MACs finalize all reconsideration requests within one year from the date a MAC deems a reconsideration request valid. A CAP reconsideration request of the flawed special stains LCD was submitted in 2021 and the revised LCDs from two MACs were just recently finalized.

To summarize, the CAP outlined key measures to the current MAC performance metrics to ensure effectiveness and adherence to LCD guidelines:

• Consistency among MAC open public meetings.
• MAC transparency and use of objective criteria for vetting and selecting subject matter experts for participation on select evidentiary panels.
• Adherence to the requirement that MACs establish a CAC and that MACs maintain a current list of their CAC members.
• Adherence to the established one-year timeframe for completing LCDs and LCD reconsideration requests unless an extension is granted by the CMS.

The CAP remains committed to working with CMS to improve the LCD process and will keep members informed of any updates in the future.