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ACP Opposes Novitas LCD

April 2, 2017

On January 19, 2017, Novitas, Inc. released a proposed a draft Local Coverage Determination (LCD) regarding Treatment of Varicose Veins of the Lower Extremities. Novitas, Inc. is a Medicare Administrative Contractor (MAC) for the Centers for Medicare and Medicaid Services (CMS) and is responsible to administering jurisdiction J-H, which includes: Arkansas, Colorado, Delaware, District of Columbia, Louisiana, Maryland, Mississippi, New Jersey, New Mexico, Oklahoma, Pennsylvania and Texas.

The Novitas LCD on varicose veins threatens to restrict coverage to a large number of Medicare beneficiaries for symptomatic venous insufficiency. The changes in the proposed LCD are a significant departure from prior Novitas policies and current LCDs from other MACs, as well as all commercial insurance carriers. The proposed policy is not consistent with published society guidelines or scientific literature, and will limit a patient’s access to appropriate medical care within those impacted areas.

In response to the Novitas policy, the ACP took immediate action in formally objecting to the proposed policy. Seven days after the policy was released, an open meeting was held at the Novitas office in Mechanicsburg, Pennsylvania on January 26, 2017. Despite the short notice, an ACP member from the area, Robert Worthington-Kirsch, MD, FSIR, FCIRSE, FACPh, RVT, RPVI, attended the meeting to represent the ACP and provide expert testimony to the Novitas panel. This testimony was given to the Novitas Medical Director who hosted the meeting, along with several other Medical Directors who were present via conference call. Dr. Worthington-Kirsch discussed several key points during his brief presentation, including existing treatment based guidelines, how the policy differs widely in criteria from other MACs, and specific issues with the policy. (Dr. Worthington-Kirsch’s account of the proceeding can be read HERE).

Following this meeting and through the wide range of contacts facilitated by the Alliance of Wound Care Stakeholders, the ACP had an opportunity to inform a member of the Novitas Mid-Atlantic Carrier Advisory Committee (CAC) about concerns with the draft LCD prior to their meeting that occurred on February 15, 2017. During this discussion, the CAC member provided a general overview of the public health perspective and policy drafting process. ACP representatives were then able to address their concerns, voice their recommendations, and present evidence to this member, with the intention that those concerns would be compelling enough to be presented during the Mid-Atlantic CAC meeting.

Knowing the importance of strength in numbers, the ACP concurrently began its membership mobilization efforts by urging members in the impacted jurisdictions to make their voices heard. A member communication was sent out by email providing background information on the policy and urging them to make public comments in opposition of the policy. The ACP also supported other organizations that wanted to share this message with their membership. In order to provide direction and maintain a consistent message to cover the main concerns of the policy, a list of specific objections were provided to be included in their comments, and individuals submitting comments were urged to use their own unique voice. In addition, key medical literature references, a sample letter, and information on how to submit comments were also provided to support their efforts. This communication went out three separate times to membership, which generated numerous calls, emails, and inquiries to the ACP Headquarters Staff, who provided support to our members’ comment efforts.

To date, 102 ACP members from the affected jurisdictions have signed on to the submitted letters, in addition to those who have contacted their representatives directly.

The ACP will continue efforts to advocate for its members and the specialty at-large. In addition, the ACP is taking steps to fulfill initiatives from the 2016-2019 Strategic Plan that will make such efforts more pre-emptive in the future.