The College of American Pathologists (CAP) sent a letter to the Centers for Medicare & Medicaid Services (CMS) on Feb. 23 urging a revision of the local coverage determination (LCD) decision-making process for Medicare Administrative Contractors (MACs). According to CAP, since the CMS 2019 revisions to the LCD guidelines, certain elements necessary for sound local coverage policy have been compromised.

CAP makes five recommendations in the letter:

  1. Noting the current involvement of Contractor Advisory Committee (CAC) representatives is insufficient in the LCD development process, CAP recommends that MACs incorporate published evidence and clinical expertise from physician CAC representatives.
  2. CAP recommends that CMS require MAC open meetings to have a more open forum to allow for information exchange between MACs and providers, physicians, beneficiaries, and caregivers. A minimum period of three weeks between an open meeting posting and the date of the meeting is also recommended. Currently, according to CAP, MAC open meetings required by CMS are focused on subject matter expert testimony of published evidence and do not always allow time for stakeholder discussion of patient needs.
  3. Currently, LCD guidelines do not have a set timeframe for MACs to complete reconsideration requests for LCD revisions, thereby creating a significant backlog of new policies. CAP recommends CMS require a final LCD on valid reconsideration requests within 180 days from when the public comment period ends. It is also recommended that MACs post a publicly accessible online tracking sheet to disclose reconsideration request information.
  4. CAP recommends that CMS require public notice and a public comment period for new and revised Local Coverage Articles.
  5. Finally, CAP recommends that CMS add key LCD process measures to MAC performance metrics, in accordance with Section 509 of the Medicare Access and CHIP Reauthorization Act of 2015, which requires contractor performance transparency when possible.

CAP plans to request a formal meeting with CMS to discuss these recommendations.