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Mark Brager
September 22, 2016

Senate Bill Would Improve Transparency, Accountability of 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 in the U.S. Senate designed to ensure Medicare beneficiary access to needed medical technologies and services:

“Millions of Medicare beneficiaries rely on Medicare Administrative Contractors (MACs) to make decisions to ensure they have access to the technologies, procedures and services they depend on.

“Unfortunately, the Local Coverage Determination (LCD) process MACs use is flawed, lacks transparency and does not provide meaningful opportunity for stakeholder input or appeals. Because of these shortcomings, American patients are at risk for being denied access to needed technologies and services.

“The Local Coverage Determination Clarification Act of 2016 introduced by Sens. Thomas Carper (D-Del.) and Johnny Isakson (R-Ga.) will address this issue by improving the transparency and accountability of the LCD process performed by MACs.

“Specifically, the legislation would:

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

“AdvaMed commends Sens. Carper and Isakson for their leadership on this issue and on behalf of the Medicare patients who will benefit from 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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