Last Modified: 1/1/2017 Location: FL, PR, USVI Business: Part A, Part B
First Coast Service Options, Inc. -- Advisory Committee Charter
The purpose of the Contractor Advisory Committee (CAC) is to provide:
• A formal mechanism for provider organizations in Florida, Puerto Rico, and the U.S. Virgin Islands to be informed of and participate in the development of local coverage determinations (LCDs) in an advisory capacity
• A mechanism to discuss and improve administrative policies that are within the contractor’s discretion
• A forum for information exchange between the contractor and provider organizations.
The focus of the CAC is Part B Medicare local coverage determinations (LCDs) and local administrative policies. Part A LCDs may be presented to solicit provider input. 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 13.8.1.
Membership on the CAC is comprised of the following:
• Doctors of Medicine
• Interventional Pain Management
• Doctors of Osteopathy
• Medical Oncology
• Doctors of Dental Surgery
• Dental Medicine
• Maxillofacial/Oral Surgery
• Nuclear Medicine
• Doctors of Optometry
• Doctors of Podiatry
• Orthopedic Surgery
• Cardiovascular/Thoracic Surgery
• Peripheral Vascular Surgery
• Emergency Medicine
• Physical Medicine and Rehabilitation
• Family Practice
• Plastic and Reconstructive Surgery
• Pulmonary Medicine
• General Surgery
• Radiation Oncology
• Internal Medicine
• Rheumatology and
• Infectious Disease
Societies to be represented include:
• State Medical and Osteopathic societies
• State representative from the National Medical Association
• Maxillofacial/Oral Surgery
Other representatives include:
• Beneficiary Association Representative
• Disabled Beneficiary Association Representative
• State Hospital Association
• Clinical Laboratory Management Association
• QIO Medical Director
• Medicaid Medical Director (or designee)
• Medical Group Management Association and
• Medicare Managed Care Representatives
Role of members
The role of CAC members is to improve the relations and communication between Medicare and the provider community.
• Disseminating proposed LCDs to colleagues in their respective state and specialty societies to solicit comments
• Disseminating information about the Medicare program obtained at CAC meetings to their respective state and specialty societies
• Disseminating information about the Medicare program and proposed LCDs to interested provider communities without representation on the CAC
• Discussing inconsistent or conflicting LCDs
• Accurately reflecting the views of their society when discussing LCDs
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 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.
• Meetings will be held a minimum of three times per year. They will be co-chaired by the Contractor Medical Director (CMD) and a physician member selected by the committee.
• Visitors/Guests - If a member or alternate would like to bring a visitor/guest, they must request permission, in writing, at least five business days prior to the meeting. Due to limited space and cost per attendee, visitors/guests are discouraged.
CAC membership requirements include:
• Physician members must be actively practicing medicine and treating Medicare beneficiaries.
• 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 must be nominated by their societies in writing. The contractor requests that the societies nominate two 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. Nominees should represent the broad practice of the entire organization.
• Periodically, the CMD will confirm the CAC membership with each society.
• CAC Co-Chair - The CAC will be co-chaired by the contractor Medical Director and one physician selected by the committee.
• Members must attend at least two meetings per year.
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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