LCD Reconsideration Process
The LCD (Local Coverage Determination) Reconsideration is a method by which interested parties can request a revision to an active LCD. The reconsideration process is available for final LCDs only. The entire LCD or any part of it is subject to reconsideration.
CIGNA Government Services may revise or retire their LCDs at any time on their own initiatives.
CGS shall consider all LCD reconsideration requests from:
- Beneficiaries residing or receiving care in a contractor's jurisdiction; and
- Providers doing business in a contractor's jurisdiction.
- Any interested party doing business in a contractor's jurisdiction
Contractors will only accept a reconsideration request for LCDs published in final form. Requests shall not be accepted for other documents including:
- National coverage Decisions (NCD);
- Coverage provisions in interpretive manuals;
- Draft LCDs;
- Template LCDs, unless or until they are adopted by the contractor;
- Retired LCDs;
- Individual claim determinations;
- Bulletins, articles, training materials; and
- Any instance in which no LCD exists, i.e., requests for development of an LCD.
If modification of the final LCD would conflict with an NCD, the request will not be valid. CGS will refer the requestor to the NCD reconsideration process at www/cms.hhs.gov/coverage/8a1.asp or www.access.gpo.gov/nara/index.html.
Requests must be submitted in writing to the following address for the following state(s):
Tennessee
CIGNA Government Services
Attention: LCD Reconsideration
Gary Oakes, MD. CMD
2 Vantage Way
Nashville , TN 37228
North Carolina
CIGNA Government Services
Attention: LCD Reconsideration
Boyd Honeycutt, MD. CMD
4135 Mendenhall Oaks Parkway
High Point , NC 27265
Idaho
CIGNA Government Services
Attention: LCD Reconsideration
Gary Oakes, MD. CMD
2 Vantage Way
Nashville , TN 37228
-- Or --
CIGNA Government Services
Attention: LCD Reconsideration
Boyd Honeycutt, MD. CMD
4135 Mendenhall Oaks Parkway
High Point, NC 27265
The request must identify the language that the requestor wants added to or deleted from and LCD. Requests shall include a justification supported by new evidence, which may materially affect the LCDs content or basis. Legible hard-copies of published evidence must be included. CGS has the discretion to consolidate valid requests if similar requests are received.
Process
- The requestor should submit a valid LCD reconsideration request to CGS.
- Within 20 days of the day the request is received, the contractor will determine whether the request is valid or invalid. If the request is invalid, CGS will respond, in writing, to the requestor explaining why. If the request is valid, the CGS will follow the requirements below.
- Within 90 days of the day the request was received, CGS 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, and revision
to a more restrictive or less restrictive policy.
If the revised policy restricts an LCD, the process for comment and notice period will be followed. The LCD does not require a comment and notice period in the following situations:
- Revised LCD that liberalizes existing LCDs
- Revised LCD being issued for compelling reasons
- Non-substantive correction
- Revised LCD that makes a clarification
- Non-discretionary coverage/[payment/coding updates
- Discretionary coding updates that do not restrict the LCD
- If the decision is to retire the LCD or make no revision, within 90 days of the day the request was received, CGS will inform the requestor of that decision with its rationale.
