Palmetto GBA Selected by CMS as New A/B Medicare Administrative Contractor for Jurisdiction 1

Palmetto GBA has been selected by the Centers for Medicare and Medicaid Services (CMS) to serve as the new A/B Medicare Administrative Contractor (A/B MAC) for Jurisdiction 1 (J1), which includes the states of California, Hawaii and Nevada, the territories of American Samoa and Guam, and the Northern Mariana Islands. This is believed to be the first selection of a carrier by CMS for the new A/B Medicare Administrative Contractor (MAC) structure.

The first phase of the Local Coverage Determination (LCD) consolidation process, namely the characterization of all active policies by topic and type, was to be completed by March 31st. The second phase, the selection of the least restrictive LCDs by topic began April 1 and will end on or before May 15, 2008. The submission of recommendations with justification to CMS will occur on an on-going basis during the April 1 to May 15th time frame. Following CMS review, all selected policies will be posted to the Medicare Coverage Database for provider notification on or before June 16. This will allow for the minimum 45 day notice period required by CMS. The Palmetto Team expects to complete the Local Coverage Determination (LCD) transition process by 8-1-2008.

The least restrictive LCD will be selected and reviewed using ad hoc policy committees, which will include members of the Part A and Carrier Advisory Committees (CAC). CMS has identified that there may be instances where the decision to implement "no policy" would meet the definition of the "least restrictive LCD". In addition, on an exception basis, CMS has also recognized that there may be instances where consideration of a more restrictive LCD may be warranted, but this too must be accompanied by a narrative providing "sufficient justification" to CMS.

The SVU will continue to monitor these consolidated carrier policies as they pertain to payment and quality standards for non-invasive vascular testing.