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Mark E. Brager
July 12, 2016

House Legislation Would Improve Medicare LCD Process

WASHINGTON, D.C. – Scott Whitaker, president and CEO of the Advanced Medical Technology Association (AdvaMed), issued the following statement after introduction of bipartisan legislation (H.R. 5721) in the U.S. House of Representatives designed to ensure Medicare beneficiary access to needed medical technologies and services:

“Through the Local Coverage Determination process, Medicare Administrative Contractors (MACs) make decisions that impact the technologies, procedures and services available for millions of Medicare beneficiaries.

“Unfortunately, the decision-making process that MACs use is flawed, lacks transparency and does not provide meaningful opportunity for stakeholder input or appeals. This is not in the best interest of American patients, who can be denied access to needed technologies and services.

“AdvaMed commends Reps. Lynn Jenkins (R- Kan.) and Ron Kind (D-Wis.) for introducing the Local Coverage Determination Clarification Act (H.R. 5721), which will improve the transparency and accountability of the local coverage determination (LCD) process performed by MACs.

“Specifically, the legislation would:

-Require open and public MAC meetings that are on the record;

-Require the disclosure by MACs of the rationale for an LCD and the evidence for that decision at the beginning of the LCD process;

-Provide stakeholders with a meaningful reconsideration process for an LCD; and

-Prohibit MACs from adopting an LCD from another jurisdiction without first conducting its own  independent evaluation of the evidence.

“These process improvements will benefit Medicare patients by ensuring greater transparency, consistency and objectivity in the LCD process. We look forward to working with members of Congress, CMS and other key stakeholders to advance this legislation.”

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