CMS Issues Modifications to LMRP Process

4/17/2002

In a transmittal letter to its carriers, CMS has issued instructions to modify the process whereby local medical review policies (LMRP) are set. The letter, which is effective October 1, 2002, states:

• When carriers receive program memoranda (PM) from CMS, they must review their LMRPs within 90 days to see how the PM impacts the LMRPs.

• With limited exceptions, final LMRPs may only be issued after a minimum public notice and comment period of 45 days.

• Open meetings for discussion of draft LMRPs must be held.

• One carrier advisory committee (CAC) must be established for each state, even if a given carrier serves several states, or if multiple carriers serve a single state.

• DME regional carriers must establish a forum of DME advisory workgroups in each region to discuss concerns of the various interested parties.

• Carriers should approve services if they are reasonable and necessary, i.e., safe and effective, not experimental or investigatory (except for routine care in qualifying trials), and appropriate in that it concord with acceptable standards of medical practice.

The transmittal letter is available on CMS' Web site at: http://cms.hhs.gov/manuals/pm_trans/R24PIM.pdf