October 7, 2024

Last week, APMA submitted a response to a Request for Information (RFI) concerning consolidation of A/B Medicare Administrative Contractors (MACs) for Jurisdiction 5 (J5) (WPS) and A/B MAC Jurisdiction 6 (J6) (NGS) and 10-Year MAC Contract Award Period of Performance issued by CMS.

As previously reported in APMA Weekly Focus, APMA participates in and coordinates the activities of a group of approximately 20 societies that have concerns about the ability for Contractor Advisor Committee (CAC) representatives to fully engage with the MACs through the Contractor Medical Directors (CMDs) and provide meaningful input to the development of local coverage policies. As part of this effort, we have identified and documented our Principles for Sound Local Coverage Policies.

In the letter, APMA responded to a number of the questions posed, largely drawing from these principles. In particular, APMA indicated that CMS should hold MACs accountable for items that contribute to effective communication and relations between CAC representatives and MACs, including by incorporating specific performance standards in their contracted scopes of work and that CMS should publicly report performance metrics that hold contractors accountable for adhering to these standards. In addition, APMA suggested that CMS should consider contractor responsiveness to CAC representative and professional society (e.g., clinical societies, medical specialty societies, other stakeholders) questions and concerns and that MACs should also implement a clear and open process for determining subject matter experts for evidentiary review panels and meetings. APMA also offered to work with CMS to develop a plan for addressing these recommendations in a deliberate manner.

To read the letter in its entirety, as well as other APMA comments, visit www.apma.org/comments.

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