Local Coverage Determination Clarification Act Introduced in House with CAP Support

The College of American Pathology (CAP) applauded the House introduction of the Local Coverage Determination Clarification Act (HR 5721) to improve transparency and accountability when Medicare contractors set local coverage determination (LCD) policies. The bill, if enacted, would ensure physician medical judgment and beneficiary access to medically necessary care are not impeded. The CAP had developed the principles in the legislation introduced by Reps. Lynn Jenkins (R-KS) and Ron Kind (D-WI). The bill seeks to ensure Medicare LCDs are made by qualified health experts through a transparent process based on sound medical and scientific evidence supported by medicine. Changes in the bill include open meetings, upfront disclosure of medical evidence and rationale, new options for reconsideration and appeal, and prohibiting the use of LCDs as a backdoor to national coverage determinations.

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