Changes to the LCD (Local Coverage Determination) Process

1/11/2019

Based on the Federal 21st Century Cures Act, the Local Coverage Determination (LCD) Development process has been modified for all Medicare contractors. The guidance for these modifications is contained in the Centers for Medicare and Medicaid Services (CMS) Change Request (CR) 10901.  As a result of these CMS modifications, for 2019, National Government Services (NGS) will be implementing the following changes to our LCD Development process and schedule.

Both Jurisdictions, JK and J6, will hold Open LCD Meetings participation 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 our NGS website.

Maintaining a Contractor Advisory Committee (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 role 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. NGS 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 at www.ngsmedicare.com.

For details regarding the LCD Development modifications you can review the Change Request on the CMS Website or review Chapter 13 of the Medical Online Manual Program Integrity Manual.