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Changes to the Local Coverage Determination Process

Based on the Federal 21st Century Cures Act, the LCD development process has been modified for all Medicare contractors. The guidance for these modifications is contained in the CMS CR 10901. As a result of these CMS modifications, for 2019, National Government Services will be implementing the following changes to our LCD development process and schedule.

Both JK and J6 jurisdictions will hold Open LCD Meetings for each LCD development cycle. The purpose of these meetings is for NGS to review the evidence leading to the coverage set forth in a proposed LCD as well as to allow presentations from stakeholders regarding coverage evidence. The meetings will be open to the public for in person and telephonic participation; however, in person capacity will be limited as will time for presentations. Detailed instructions regarding the logistics of each Open LCD Meeting (registration, location, etc.) will be forthcoming in a separate announcement on this website.

Maintaining a CAC is still a requirement; but a formal CAC meeting is discretionary. The CAC meeting, when held, will occur prior to the development of a Draft LCD and LCD Open Meeting. The purpose of the CAC meeting is to provide a forum for discussion of evidence on topics under consideration for an LCD; such input will be used as a source of information in the formation of the draft LCD. CAC meetings will be telephonic and open for public attendance. CAC members are free to attend the LCD Open Meeting as well.

This process is new to NGS, CAC members, stakeholders and providers. We will remain flexible as 2019 progresses to modify, within CMS guidelines, the operational aspects of LCD development (i.e. timing, location, discretion to hold a CAC Meeting, etc.) and will maintain a transparent communication approach via our website.

Again, please look for details regarding the next upcoming Open LCD Meetings (tentatively set for February 2019) on our website.

For details regarding the LCD development modifications, you can review CR 10901 on the CMS website or review the CMS Internet-Only Manual Publication 100-08, Medicare Program Integrity Manual, Chapter 13.

Posted 1/11/2019

Last Modified: 1/14/19
Changes to the Local Coverage Determination Process
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