Are You Involved with Your Local Contractor Advisory Committee?

The Centers for Medicare & Medicaid Services (CMS) contracts with insurance carriers known as Medicare Administrative Contractors (MACs) to administer the Medicare program in assigned jurisdictions. In addition to processing and paying claims, the MAC’s scope of work includes establishing Local Coverage Determinations (LCDs) for certain services when there is no established national policy. While the Contractor Medical Director (CMD) makes all final determinations, they do receive input from a variety of sources including the Contractor Advisory Committee (CAC).

MACs must form CACs for each state within their jurisdiction. CAC representatives provide CMDs with specialty-specific input and comments on certain LCDs, which define the conditions that must be present for a specific procedure/service to be covered. At the beginning of the policy-making process, CMDs release draft LCDs with a 45-day minimum comment period. During that time, CMDs may receive input from CAC members, impacted physicians/specialty societies, and other interested stakeholders. All neurologists, APPs, and business administrator membership types can join their local CAC. If you are concerned about government payment matters, the AAN encourages you to join your state’s CAC. Being a CAC representative, you experience a much deeper understanding of how policy development works. If you are unable to serve on the CAC yourself, you should encourage members of your practice or state component society to join. The CAC only addresses Medicare, but the influence of Medicare decisions carries weight for many other payers.

José M. Rocha, MHL, director for FirstChoice Neurology in Medley, FL, explained why it is important to be a member of a CAC. “On the team I am on, there is an ophthalmologist, retired podiatrist, and nephrologist. None are qualified to speak on EMG/NCV, SUDOSCAN, Botox injections, or VNG—all policies that were updated in 2023 for our MAC.

“CMS comes up with policies due to statistical reports. These statistical reports have no meaning unless a provider of this care can explain why an office visit might be necessary for a Botox patient. Or why this diagnosis is appropriate for this procedure. Or why the procedure might be repeated twice in a year or more. Being involved is crucial to make sure neurology patients’ needs are represented in payment policies that might affect the delivery of care.”

If you are a member of your local CAC, or if you are interested in learning more about the CAC selection process or about your local CAC, contact practice @ aan.com 