Revised Medical Program Integrity Manual Is a ‘Roadmap’ to LCD Process
- By BSTQ Staff
The Centers for Medicare and Medicaid Services has revised Chapter 13 of the Medicare Program Integrity Manual to include instructions, policies and procedures that Medicare Administrative Contractors (MACs) use to administer the Medicare fee-for-service program. The revisions, the first since August 2015, revamp the format of the manual so it can be used as a “roadmap” for the local coverage determination (LCD) process. Important changes include:
- Requiring a consistent, standardized summary of the clinical evidence supporting LCD decisions;
- Including a beneficiary representative and other healthcare professionals in addition to physicians such as nurses and social workers on Contractor Advisory Committees that inform LCDs; and
- Ensuring Contractor Advisory Committee meetings are open to the public.
In addition, the revisions include a new process that takes further steps to be responsive to patient needs by allowing patients to request a new LCD and by holding open meetings virtually (e.g., by webinar) instead of in-person to allow for broader participation.
A full list of changes to the manual can be found at www.cms.gov/newsroom/fact-sheets/summary-significant-changesmedicare-program-integrity-manualchapter-13-local-coverage.
References
CMS Accelerates Innovation and Promotes Patient Access to Medical Technology. Centers for Medicareand Medicaid Services press release, Oct. 3, 2018. Accessed at www.cms.gov/newsroom/press-releases/cms-accelerates-innovation-and-promotes-patient-access-medicaltechnology.
