Summary of Significant Changes to the Medicare Program Integrity Manual Chapter 13 – Local Coverage Determinations

The Centers for Medicare & Medicaid Services (CMS) has revised chapter 13 of the Medicare Program Integrity Manual (PIM). This chapter describes the local coverage determinations (LCD) process.

The revision was in response to a provision of the 21^st Century Cures Act intended to improve transparency in the LCD process.

• Clear process “roadmap.”
• Consistent presentation of evidence.
• Informal meetings with MACs.
• New LCD request process.
• Restructured Contractor Advisory Committee (CAC) meetings.
• More voices on CAC.
• Repurposed public meetings.
• No “old” proposed policies.
• Relocation of codes.
• Better communication.
• Consistent reconsideration process.

Source: https://www.cms.gov/newsroom/fact-sheets/summary-significant-changes-medicare-program-integrity-manual-chapter-13-local-coverage