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Local Coverage Determination Clarification Act of 2018

Floor Speech

Date: Sept. 12, 2018
Location: Washington, DC


Ms. JENKINS of Kansas. Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 3635) to amend title XVIII of the Social Security Act in order to improve the process whereby medicare administrative contractors issue local coverage determinations under the Medicare program, and for other purposes, as amended.

The Clerk read the title of the bill.


Ms. JENKINS of Kansas. 3635, currently under consideration.

Mr. Speaker, today, I rise in support of H.R. 3635, the Local Coverage Determination Clarification Act. I introduced this legislation along with Congressman Kind, which will help ensure the Medicare coverage decisions are made by qualified health experts through a transparent process that is based on sound medical evidence.

Medicare administrative contractors, or MACs, play a critical role in ensuring that Medicare beneficiaries have access to needed care. However, the less-than-transparent process used by MACs to make coverage decisions can limit or deny patients' access to necessary care.

Specifically, the science that guides some of these decisions can be flawed, mischaracterized, or misapplied. The deliberations and decisions of the MACs, which should be based on medical science, are often conducted behind closed doors, with little opportunity for interested stakeholders to raise issues or offer alternatives. These decisions affect millions of Medicare beneficiaries and impact crucial access to innovative technologies and services.

The establishment of a clear process informed by health experts will make the local coverage determination, or LCD, process and the decisions developed by that process more sound, more transparent, and ensure accountability among MACs. These requirements are necessary to ensure that our Nation's seniors receive quality healthcare treatment.

Specifically, H.R. 3635 would improve the LCD process by requiring that carrier advisory committee meetings of the MAC are open, public, and on the record, with minutes taken and posted to the MAC's website for public inspection. The gravity of limiting or precluding coverage for both beneficiaries and practitioners heightens the need for transparency, especially when such meetings are currently closed off.

MACs would be required to include, at the outset of the coverage determination process, a description of the evidence a MAC considered when drafting a local coverage determination as well as the rationale it relies on to deny coverage.

Additionally, under current rules, local coverage determinations are essentially unreviewable once they become final. This legislation would create a process for stakeholders to request additional review of a MAC's local coverage decision from the Centers for Medicare and Medicaid Services.

It would also require the Secretary to submit a report to Congress regarding the number of requests filed with fiscal intermediaries and carriers and the number of appeals filed with the Secretary, as well as the actions in response. Additionally, the report would recommend ways to improve the usefulness and efficiency of the process as well as the communication with Medicare beneficiaries and providers.

While I am pleased that the legislation we have here today takes steps to improve the process and bring transparency to protect access for Medicare patients, we must continue to work to ensure that MACs independently evaluate the evidence of other MACs' coverage decisions. Local coverage determinations should be thoroughly evaluated by experts in each local jurisdiction.

Currently, loopholes in the process allow contractors to adopt another MAC's coverage determination without the necessary scientific rigor and meaningful engagement with stakeholders that is vital in forming the most appropriate policy. Due to regional, geographic, and population-based deficiencies, these carbon-copied LCDs may not reflect the specific geographic region they are intended to serve. Local coverage determinations should be just that--local.

Put simply, what works best for one location does not always work best for another location. Applying local coverage determinations across jurisdictions has the practical effect of establishing national coverage policies without having followed the more rigorous national coverage determination process. As such, I look forward to working with my colleagues on this issue, moving forward.

Medicare beneficiaries deserve transparency and accountability for these decisions that directly impact their access to care. These reforms are necessary to ensure that local coverage determinations do not impede a physician's medical judgment and deny patients access to medically necessary care. By changing the LCD process, Congress can ensure that medical and scientific evidence is not used selectively to deny appropriate coverage to seniors.

I want to thank Mr. Kind, who joined me in introducing this legislation.

I want to ask my colleagues for their bipartisan support of this bill as we work to improve access and care for every American.

Mr. Speaker, in closing, I am proud to stand here today in support of this commonsense legislation that creates transparency and accountability to the local coverage determinations process and will help ensure that Medicare patients receive the medical care they need.

Mr. Speaker, I hope everyone will join me in voting for this legislation on the House floor today as we work to improve access and care for every American, and I yield back the balance of my time.