ACR urges Congress to address ‘suboptimal’ Medicare local coverage determination process
The American College of Radiology is urging lawmakers to fix the flawed process for gaining local coverage determinations under the Medicare program.
Congress was supposed to have addressed this issue via the 21st Century Cures Act of 2016, directing Health and Human Services to improve transparency in LCDs. However, years later, Medicare Administrative Contractors’ responsiveness to radiologist concerns remains “suboptimal” at best, the college wrote in an Aug. 2 letter to lawmakers.
Making matters worse, MACs have “effectively omitted” any physician representatives from Contractor Advisory Committees. These bodies were created to give the healthcare community a formal avenue to get involved with coverage determinations.
“Further improvements are needed to restore opportunities for the physician community to meaningfully engage with the MACs to inform the development of local coverage policies,” ACR CEO Dana H. Smetherman, MD, MBA, wrote earlier this month. “[Contractor Advisory Committee] meetings now occur less frequently, randomly, or not at all, due to how contractors have deprioritized CAC/physician engagement and devalued their advisory responsibilities.”
The new college leader’s letter came in response to a June request for information from U.S. Reps. Diana DeGette, D-Colo., and Larry Bucshon, MD, R-Ind. Both sent a message to healthcare stakeholders, interest groups and advocates seeking ways Congress can “bring about the next generation of treatments.” Rep. DeGette previously introduced the Cures 2.0 Act in 2021, to build upon the original legislation. The deadline to submit comments was Aug. 2.
“The 21st Century Cures Act has been tremendously successful in accelerating scientific understanding, spurring innovation, and bringing new treatments to patients,” Reps. DeGette and Bucshon said in a statement. “Today, we are beginning a new chapter in the legacy of 21st Century Cures, and we look forward to hearing ideas on how Congress can help power our research infrastructure and deliver treatments to the patients who need them.”
ACR and Smetherman see modifications to Medicare coverage determination as crucial in this process. As things stand, MAC decisions do not come with adequate public notice nor opportunities to comment. This has resulted in “misinformed policymaking” and a lack of clear guidelines on how to select proper subject matter experts.
The college wants Congress to mandate that LCD process requirements are “more aligned with federal transparency standards.” This could include regular meetings held at least twice per year in each jurisdiction, and eight weeks of advance notice for LCD topics under consideration.
“Finally, MACs should be required to publish the draft coding/billing policies associated with LCDs for meaningful public comment in local coverage articles,” Smetherman added.
Fixing LCD was one of seven recommendations proposed by the ACR for any future iterations of Cures. Here’s the full list:
- Broadening the FDA’s authority over healthcare artificial intelligence.
- Creating payment incentives for quality use of high-value AI.
- Mandating a national strategy to advance image exchange.
- Improving the Medicare local coverage determination process.
- Supporting progress made by the Advanced Research Projects Agency for Health (APRA-H).
- Funding translational research.
- Improving National Institutes of Health efficiency and data-sharing.
You can read the full letter to lawmakers here and a summary from the college’s News Hub here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.