Last Modified: 5/14/2020
Location: FL, PR, USVI
Business: Part A, Part B
The purpose of the CAC is to provide a formal mechanism for healthcare professionals to be informed of the evidence used in developing the local coverage determination (LCD) and promote communications between the MAC and the healthcare community. The CAC consists of organizations in Florida, Puerto Rico, and the U.S. Virgin Islands.
The focus of the CAC is Part A and Part B Medicare LCDs and local administrative policies. The CAC is not a forum for advising the Centers for Medicare & Medicaid Services (CMS) or for influencing national Medicare decisions, policies, or administrative procedures. These issues should be addressed by individual national societies. The CMS outlines the purpose and role of the CAC in its Program Integrity Manual (PIM) Section 126.96.36.199.
The CAC is to be composed of healthcare professionals, beneficiary representatives, and representatives of medical organizations. The CAC is used to supplement First Coast’s internal expertise and to ensure an unbiased and contemporary consideration of "state of the art" technology and science. CAC members are valued for their background, education, experience and/or expertise in a wide variety of scientific, clinical, and other related fields. First Coast shall endeavor to ensure each specialty that serves on the CAC shall have at least one member and a designated alternate approved by First Coast.
CAC members should serve in an advisory capacity as representatives of their constituency to review the quality of the evidence used in the development of an LCD. The CAC is advisory in nature, with the final decision on all issues resting with First Coast. Accordingly, the advice rendered by the CAC is most useful when it results from a process of full scientific inquiry and thoughtful discussion with careful framing of recommendations and clear identification of the basis of those recommendations.
The CAC will have the following structure:
• Each designated specialty will have one member and one alternate. If the representative and alternate for a society attend the same meeting, the alternate will be an “observer.”
• If the CAC representative or the alternate cannot attend, the Contractor Medical Director (CMD) should be notified in writing, at least five business days prior to the CAC meeting, of a substitution for the member. This substitution should be infrequent. If it becomes frequent, the CMD will ask the society to replace that member or name the substitute as an alternate.
• Contractors have the option of hosting in-person and/or telephonic/video/on-line conference/etc. meetings. All CAC meetings will be open to the public to attend and observe. Portions of the meeting not discussing evidence for a proposed LCD, such as provider practice trend reporting or discussions related to fraud and abuse, may be closed to the public.
CAC membership requirements include:
• Physician members should be board-certified and actively practicing medicine and treating Medicare beneficiaries or have had many years of experience in the practice of medicine. Non-physician practitioner members should have attained certification of competency as provided by their discipline and should be actively practicing.
• Members’ utilization statistics and practice patterns must demonstrate that they compare favorably to those of their peers in the same specialty and practice.
• Members must not be the subject of an active investigation by law enforcement agencies.
• Members must not be the subject of a Contractor fraud referral to law enforcement for investigation/prosecution.
• Candidates should be nominated by their societies in writing or by email. The Contractor requests that the societies nominate two (2) candidates for each position. The standard term will be three years; however, societies may nominate their representatives for an additional term, at the discretion of the CMD. Periodically, the CMD will confirm the CAC membership with each society.
• Members should attend in person or by telephone/electronic means the majority of the meetings. The CMD may ask the society to replace members who do not attend meetings, do not respond to requests, and/or are not fulfilling the duties as listed.
• Members must review the Disclosure of Potential Conflicts of Interest and declare any potential conflict of interest at the beginning of each CAC meeting or when providing comments.
Note: The above requirements will be verified prior to acceptance of new members. If existing members, at some point, do not meet the criteria, they will be temporarily or permanently removed. In the case of a temporary suspension or permanent removal, the alternate will be requested to attend. The respective medical society will also be contacted by the CMD. He or she will request a temporary or permanent replacement for their member. This new member will then be subject to the above screening process.
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