CMS Announcement – MAC transition date for Jurisdiction 6 (Illinois, Minnesota and Wisconsin)

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National Government Services Assumes J6 Medicare

Contractor Responsibilities on 07/01/13

The CyberKnife Coalition would like to make you aware of a recent announcement by CMS regarding the MAC transition date for Jurisdiction 6, comprised of Illinois, Minnesota, and Wisconsin. The current Medicare Administrative Contractor (MAC), Wisconsin Physician Services (WPS), lost this contract approximately 6 months ago to National Government Services (NGS), the current Medicare contractor for Jurisdiction 13 (Connecticut and New York). Shortly after the award was announced, WPS filed a protest with CMS and a stop work notification was issued. The United States General Accountability Office (GAO) reviewed the award and denied WPS’ protest and instructed CMS to implement the contract with NGS. CMS recently issued an announcement indicating that NGS will assume all Jurisdiction 6 MAC responsibilities on 07/01/13.

The current J6 contractor, WPS, has active local coverage determinations for both SRS (WPS LCD L30318) and SBRT (WPS LCD 28366) located on the CMS Website at: www.cms.gov/medicare‐coverage‐database

The incoming contractor NGS, however, does not have a local coverage determination specific to SRS or SBRT. In the absence of a national or local coverage determination, coverage for medical procedures is subject to the general “reasonable and necessary” criteria of the Medicare program. As Medicare contractors assume new jurisdictions, usually the incoming contractor will merge their own polices with ones previously established by the outgoing contractor. If both contractors have a local coverage determination in place for the same technology, CMS requires that the incoming contractor choose the “most clinically appropriate” LCD. Since WPS has SRS/SBRT policies, and NGS does not, the most likely scenario will be NGS adopting the existing WPS policies. Therefore, we believe that in terms of coverage, there will be no significant changes for providers in the states of Illinois, Minnesota, and Wisconsin.

The CyberKnife Coalition will continue to monitor this transition and provide its members with any relevant policy updates.