AANA Updates

AANA Applauds House Passage of Local Coverage Determination Clarification Act

  • Sep 13, 2018

For immediate Release: September 13, 2018
For more information, contact: AANA Public Relations

Park Ridge, Illinois —The American Association of Nurse Anesthetists (AANA) applauds the U.S. House of Representatives for its passage of H.R. 3635 – the Local Coverage Determination Clarification Act. AANA was joined by more than 25 other health and medical associations in its support of the bill, which amends title XVIII (Medicare) of the Social Security Act to revise the process by which Medicare Administrative Contractors issue and reconsider local coverage determinations that are new, restrict or substantively revise existing determinations, or are otherwise specified in regulation.

“We commend the House for its understanding of the importance of greater transparency, consistency and objectivity when making local coverage determinations for Medicare, which will ultimately benefit both patients and providers,” said AANA President Bruce Weiner, DNP, MSNA, CRNA.

Local coverage determinations (LCDs) are policies made by Medicare Administrative Contractors (MACs) on whether to cover a particular item or service in a MAC’s jurisdiction (region) in accordance with section 1862(a)(1)(A) of the Social Security Act. Through LCDs, MACs create their own rules that may contradict existing CMS regulations and policy as well as scope of practice under state law.

H.R. 3635 outlines a set of standards that MACs must adhere to before any LCD meeting in order for the above criteria to take effect, including:

  • Publishing online a proposed version of the determination and other specified, related information;
  • Convening one or more public meetings to review the draft determination, receive comments, and ensure that meetings of the MAC’s advisory panel are on record;
  • Posting online a record of the minutes from each such meeting;
  • Providing a period for submission of written public comments; and
  • Posting online specified information related to the rationale for the final determination.

“As private insurers, MACs currently have the ability to utilize their own reconsideration process for local coverage determinations. H.R. 3635 will put protections in place for both patients and providers to ensure a standardized and unbiased process,” said Ralph Kohl, Senior Director of Federal Government Affairs for the AANA.

MACs base coverage decisions on whether the service or item is considered reasonable and necessary. Among other standards, H.R. 3635 would require disclosure of the evidence relied upon and rationale used for decisions, ensuring LCDs are issued for necessary reasons and providing patients and providers with a meaningful, third-party reconsideration process should they disagree.

“Furthermore, by requiring MACs to conduct their own independent evaluation of the evidence, H.R. 3635 will prevent ‘backdoor’ Medicare National Coverage Decisions in which LCDs are adopted from outside jurisdictions,” said Kohl.

For more information on AANA’s work with the Centers for Medicare & Medicaid Services to ensure safe, high-quality and cost-effective healthcare, visit www.future-of-anesthesia-care-today.com/legislators.php.

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