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Alliance of Wound Care Stakeholders Advocacy Update
05/03/2017
Newly introduced legislation aims improve MAC LCD transparency, accountability
New proposed legislation introduced in Congress with bipartisan support provides hope that many of the issues the Alliance and our members have faced with the Medicare Administrative Contractors (MACs) local coverage determinations (LCDs) may have a legislative fix moving forward. The proposed legislation,"Local Coverage Determination Clarification Act of 2017" (S.794), would improve transparency and accountability when Medicare contractors set local coverage determination (LCD) policies for physician services provided to Medicare beneficiaries.
The Medicare Administrative Contractors (A/B MACS and DME-MACs) across the U.S. are responsible for local coverage decisions that impact millions of Medicare beneficiaries, determining which technologies, procedures and services are available to them. The Alliance has long emphasized in comments that the LCD process is flawed, lacks transparency, does not seem based on sound medical evidence and does not provide meaningful opportunity for stakeholder input or appeals. The result of this has been that wound care providers' ability to treat patients with the technologies and services they need has been comprised. This has been particularly evident in the field of HBOT and NPWT, but is also pervasive across the wound care space and indeed, across the entire health care space - hence the action from Congress.
This legislation addresses some of these concerns by:
- Requiring open and public MAC meetings that are on the record;
- Requiring disclosure by MACs of the rationale for an LCD and the evidence for that decision at the beginning of the LCD process;
- Providing a meaningful reconsideration process for an LCD;
- Prohibiting MACs from adopting an LCD from another jurisdiction without first conducting its own independent evaluation of the evidence.
The Alliance supports each one of these provisions. The final item on the list above, prohibiting MACs from adopting each other's LCD language without independent assessment, is particularly relevant to us in the wound care space today.
As you will read below, in the past few months, both Novitas and First Coast Service Option issued nearly identical wound care LCDs with nearly identical restrictions and limitations. This has been a trend that has been increasingly expanding, the result of which is that a policy introduced by one MAC - then broadly adopted by others without sufficient review - by default starts becoming more of a National Coverage Decision in practical terms without having followed more rigorous requirements. This legislation would put a clear stop to that practice of LCDs mirroring each other region by region, with the same flaws and inaccuracies repeated again and again.
While there is a long road ahead for the bill to move from "proposed" to "passed" and implemented, this finally shows that our Alliance concerns are shared across the entire healthcare sector, and that the MAC issues are pervasive and concerning enough to merit the bipartisan attention of Congress. The bill in its proposed form would significantly address our requests for improved MAC transparency and accountability - and the very introduction of it, even without passage, sends a powerful signal to MACs.
The Alliance will be voicing our support to the bill's co-sponsors as well as urging other to sign-on and move the legislation forward. In the Senate, the legislation was introduced by Sens. Johnny Isakson (R-Ga.), Thomas Carper (D-Del.), Debbie Stabenow (D-Mich.) and John Boozman (R-Ark.). We will share our letters with membership. We encourage each of you to have a voice and, through your own individual organizations, submit your own letters of support to Congress. We will also await the House version of the bill and support this as well.
The Alliance of Wound Care Stakeholders is an association of physician and clinical organizations focused on promoting quality care and access to procedures and technologies for patients with wounds through advocacy and educational outreach in the regulatory, legislative and public arenas. The Alliance unites leading wound care experts to advocate on public policy issues that may create barriers to patients' access to treatments or care, with a focus on reimbursement, wound care research and wound care quality measures.
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