APMA Addresses CAC Engagement and Cross Agency Issues with CMS | News | APMA
APMA Addresses CAC Engagement and Cross Agency Issues with CMS

October 3, 2022

diverse group of doctors collaborating, group high

On September 30, APMA and its CAC engagement coalition held a call with CMS in furtherance of their Carrier Advisory Committee (CAC) engagement efforts to address cross-agency issues with CMS.

APMA and the coalition have experienced several challenges with the Local Coverage (LC) process in recent years and have brought those concerns to CMS’ Coverage and Analysis Group (CAG). The CAG has considered APMA’s concerns and is working to address many of them on an ongoing basis.

As previously reported in APMA Weekly Focus, the CAG has raised many of our concerns regarding CACs with the MAC medical directors, who have developed a working group to address concerns raised by this group, and with whom we are engaged to continue to work through several issues. However, other issues have hit roadblocks, so APMA requested this meeting with CMS to facilitate cross-agency engagement on these issues to help advance goals of transparency, burden reduction, and sound policy.

Specifically, APMA and the coalition again raised the following issues:

  • Lack of notice and comment regarding articles that determine coverage
  • Proper nomenclature and placement issues for “Articles” across CMS that do not address coverage
  • Performance metrics and additional accountability for MACs , including adhering to LCD timelines, new standards for CAC engagement, requirement to always include a draft LCA with the draft LCD for notice and comment
  • Need for an ombudsman to coordinate these issues

This meeting continues APMA and the coalition’s efforts to address lingering concerns regarding the Local Coverage Determination (LCDs) and Article (LCAs) review process, role of the CAC representatives, and other issues that APMA and our coalition have raised related to changes brought about by the 21st Century Cures Act.

Read more about APMA’s advocacy and the CAC process at www.apma.org/cacpiac and www.apma.org/medicare.


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