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- CAP Warns of Negative Consequences in Proposed MAC Consolidations
The CAP has raised concerns over proposed consolidations of Medicare Administrative Contractors (MACs) and the potential for adverse coverage decisions that would harm seniors and other patients. In an Oct. 4 comment letter, the CAP said the effect of the proposed consolidations may lead to exclusions or limits on coverage for Medicare populations without appropriate stakeholder input. The CAP has advocated for increased MAC consistency and transparency because consolidation and mismanaged coordination between MACs can lead to the spread of a poorly developed local coverage determination (LCD), inappropriately limiting coverage for Medicare beneficiaries.
The Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) on September 4, seeking public feedback on consolidating Medicare Administrative Contractor (MAC) jurisdictions from four to two and awarding future MAC contracts with a 10-year period of performance, from the current seven-year term.
Additionally, these decisions may not reflect the specific geographic region they are intended to serve. CAP strongly encourages CMS to address existing flaws in the current LCD process before considering any further MAC consolidations so as not to exacerbate existing problems with the local coverage process.
The CAP also said that workload distribution and cybersecurity risks are examples of consolidation aspects that require further analysis. The CAP recommended that the CMS ensure an equitable workload to help maintain a fair distribution.