Many health insurance companies follow Medicare policy regarding access to services and reimbursement. Because of this, Medicare advocacy reverberates powerfully.
CMS, the Center for Medicare/ Medicaid Services is the national, federal Medicare organization. Federal law mandates that Medicare is administered regionally. The regional administrators are called MACs (Medicare Administrative Carriers). Click here for a map of the Medicare MACS. Each MAC is advised by a Carrier Advisory Committee. Healthcare providers from all specialties may be asked to become members of the CAC and serve as a conduit between the MAC and their professional organizations. Members also provide input to the MAC medical director in creating Local Coverage Determinations (LCDs).
Local Coverage Determinations (LCDs) are the regional rules that govern what services are covered. For example, whether Transcranial Magnetic Stimulation is reimbursed is a regional MAC decision. Some MACs have allowed reimbursement for TMS, others have not.
Periodically, LCDs go into draft status. When this occurs, the MAC will propose new language, changing the local rules governing the service covered by the LCD. For example, a Neuropsychology LCD might go into draft status, with the MAC proposing new language about when and how neuropsychology services are covered. There is a comment period, where CAC members and members of the larger community can argue for or against the new wording, and propose additional language. The draft LCD process is a powerful advocacy tool, particularly as many health insurance companies in turn adopt the LCD policies.
Neuropsychology Medicare Impact Network
90% of all Medicare coverage decisions are made through the Local Coverage Determination process (LCD), controlled by the Medicare Administrative Contractors (MACs). Coverage decisions made by each MAC may influence coverage decisions in other MACs, and have a profound effect on coverage decisions in the private insurance market. The Inter Organizational Practice Committee (IOPC) is developing a national network of neuropsychologists to provide input into the LCD decision-making process through participation in their state’s Carrier Advisory Committee (CAC).
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Neuropsychology Advocacy with Local Coverage Determinations