More than 35 bipartisan members of the House of Representatives cosigned an October 1, 2018, letter to the Secretary of the Department of Health and Human Services and the Administrator of the Centers for Medicare and Medicaid Services (CMS) to express opposition to Medicare Administrative Contractors (MAC) that deny reimbursement for low-dose CT (LDCT) lung cancer screenings performed at Independent Diagnostic Testing Facilities (IDTFs).
Patients are required by law to have free access to LDCTs for early detection of lung cancer regardless of whether they receive health insurance via private carriers or Medicare. In December 2013, the United States Preventive Services Task Force (USPSTF) issued a new, higher grade of “B” for LDCTs and, per the provisions of the Patient Protection and Affordable Care Act (PPACA), private insurers are required to offer patients between the ages of 55 and 80 with a 30-year pack history of smoking annual LDCTs without any form of cost-sharing.
In February 2015, CMS also issued a Medicare National Coverage Determination (NCD) that found sufficient evidence for patients between the ages of 55 and 77 with a 30-year pack history of smoking to receive annual LDCT lung cancer screenings without cost-sharing. Medicare and private insurance must cover the cost of such LDCTs for age-qualified patients who were heavy smokers in the past and have ceased tobacco use within the last 15 years as well.
One of the many mandates in the Medicare lung cancer screening NCD is for all radiology facilities, including physician offices, hospital outpatient departments and IDTFs, to make available written smoking cessation interventions for current smokers. Their related smoking cessation brochures are designed to complement the intense smoking cessation counseling that qualified patients receive during mandated shared decision-making visits or in discussions between treating physicians and patients regarding the benefits and drawbacks of LDCT lung cancer scans. Shared decision-making visits must be completed before patients may begin the annual screening regiment.
MACs, which are responsible for enforcing the lung cancer screening NCD, claim that written smoking cessation interventions qualify as a therapeutic intervention. IDTFs are prohibited from providing services that are solely therapeutic and, as a result, patients who receive LDCT lung cancer screening in this particular setting are forced to pay out-of-pocket for the procedures.
Though CMS has communicated to the American College of Radiology (ACR) that IDTFs are, in fact, supposed to be authorized to provide LDCT lung cancer screenings, the agency is deferring to MACs for enforcement of the NCD. Rather than issuing a written Change Request Transmittal clarifying that smoking cessation brochures are not defined as therapeutic services, CMS claims that it must reopen the entire NCD in order to make this technical correction.
The letter led by Representatives Jim Renacci (R-OH), Larry Bucshon, MD (R-IN), Bill Pascrell (D-NJ) and John Larson (D-CT) urges CMS to avoid the laborious process of reopening the lung cancer screening NCD. To preserve patient access to these lifesaving screening services, the bipartisan members of Congress, many of whom serve on the powerful House Ways and Means and Energy and Commerce Committees, support having CMS issue a Change Request Transmittal.
The ACR, in conjunction with the Lung Cancer Alliance, Association for Quality Imaging (AQI) and Radiology Business Management Association, applaud Congressmen Renacci, Bucshon, Pascrell, and Larson for sending this important communication to HHS and CMS. The ACR and its coalition partners hope Congressional pressure will prompt CMS to quickly rectify this issue.
ACR members are encouraged to closely monitor Advocacy in Action eNews for the latest developments pertaining to LDCT lung cancer screening and restrictions that have thus far limited their application by IDTFs.