June 27, 2018
2 min read

Legislation aims to revise Medicare administrative contractors process in Local Coverage Determination

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WASHINGTON – Legislative changes are needed regarding the process in which Medicare and their contractors decide what will and will not be covered, according to one speaker at the Renal Physicians Associations’ Nephrology Coverage Advocacy Program meeting.

Michael Giuliani

Michael Giuliani, senior director of legislation and political action for the College of American Pathologists, spoke to the attendees about the process Medicare administrative contractors (MACs) go through when making decisions about Local Coverage Determinations (LCDs).

“Essentially, we want MACs to provide a summary of the evidence they consider during the LCD development and an explanation for the rationale that supports the proposed LCD at the beginning of the process,” Giuliani said. “LCDs impact physician practices and beneficiaries because they limit or deny coverage. So, we think it should be standard practice to include this information at the time that the draft LCD is released so all the stakeholders can be informed.”

Last year, two pieces of legislation were introduced before the Senate, S. 794, and the House, H.R. 3635. Currently, they have 18 and 64 cosponsors, respectively. According to Congress’s website, the proposed bill aims to revise the process by which MACs issue and reconsider LCDs that are new, restrict or substantively revise existing LCDs or are otherwise specified in regulation.

Giuliani was happy that the Nephrology Coverage Advocacy Program has joined the coalition in Washington, and said that currently there are 120 organizations supporting the legislation. Support comes from industry, physician groups and patient groups, according to Giuliani.

“What you’re trying to do is you’re trying to show support, you’re trying to generate some momentum so that when the committee chair and the ranking member of the committee or the leadership in the House and the Senate are looking for bipartisan legislations, something that has strong support, they’ll pick this up with the committee.”

Giuliani previously served as chief of staff to two members of Congress, and currently works as a lobbyist. He stressed the importance of voicing concerns over legislation to get action into motion.

“If people are talking and concerned and coming to Washington and taking time out of their busy schedule to come meet with us on the Hill, that has an impact,” Giuliani said. – by Jake Scott