Beacon

LCD Comment and Reconsideration Processes

NOTE: These processes are NOT the processes relating to a claim “redetermination” (“APPEAL”).

Local Coverage Determination (LCD) Comment Process

LCDs that are in DRAFT are open for comment. The draft LCD document outlines the comment period. Comments may be received in one of the following manners:

  • Email:
    LCDComment@cahabagba.com
  • Fax:
    205-220-1218, Attn: Contractor Medical Director
  • Write:
    Cahaba GBA
    Comments for Draft LCDs
    Attention: Contractor Medical Director
    Post Office Box 381896
    Birmingham, AL 35238-1896
LCD Reconsideration Process

The LCD Reconsideration Process is a mechanism by which interested parties can request a revision to an LCD. This contractor will consider all LCD reconsideration requests from:

  • Beneficiaries residing or receiving care in this contractor’s jurisdiction;
  • Providers doing business in this contractor’s jurisdiction: and
  • Any interested party doing business in this contractor’s jurisdiction.

This contractor will only accept reconsideration requests for LCDs posted in FINAL FORM.

Process

Requests must be submitted in writing, and must identify the language that the requestor wants added to or deleted from a LCD. Requests must include a justification supported by new evidence, which may materially affect the LCD’s content or basis. The level of evidence required for LCD reconsideration is the same as required for new/revised LCD development.

Contractors have the discretion to consolidate valid requests if similar requests are received. Within 30 days of the day the request is received, the contractor will determine whether the request is valid or invalid.

If the request is invalid, the contractor will respond, in writing, to the requestor explaining why the request was invalid.

If the request is valid, the contractor will follow the requirements below.

  • Within 90 days of the day the request was received, the contractor will make a final LCD reconsideration decision on the valid request and notify the requestor of the decision with its rationale. Decision options include retiring the policy, no revision, revision to a more restrictive policy, or revision to a less restrictive policy.
  • If the decision is either to retire the LCD or to make no revision to the LCD, then within 90 days of the day the request was received, the contractor will inform the requestor of that decision with its rationale.
  • If the decision is to revise the LCD, the normal process for LCD development will be followed.

Reconsiderations may be submitted in one of the following manners:

  • Email:
    LCDReconsideration@cahabagba.com
  • Fax:
    205-220-1218, Attention: Contractor Medical Director
  • Write:
    Cahaba GBA
    Reconsiderations for Active LCDs
    Attn: Contractor Medical Director
    Post Office Box 381896
    Birmingham, AL 35238-1896

For more detailed information regarding LCD comments or reconsiderations please reference the Program Integrity Manual, Chapter 13.

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