May 30, 2023

2 min read

MACs Back Off Plans to Pursue RPM and RTM Local Coverage Determination

Two Medicare administrative contractors (MACs) that co-hosted a multi-jurisdictional meeting to discuss efficacy of remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) have announced they will not pursue a local coverage determination (LCD) on RPM and RTM for non-implantable devices.

The February multijurisdictional contractor advisory committee (CAC) meeting, hosted by Novitas Solutions and First Coast Service Options, was intended to obtain advice from CAC members and subject matter experts concerning the strength of published evidence on RPM and RTM for non-implantable devices as well as clinical data that could be used to better define meaningful and measurable patient outcomes, such as decreases in emergency room visit and hospitalizations, for Medicare beneficiaries. Four of the other five MACs participated in the CAC meeting.

CAC meetings are generally precursors to LCDs, which is a determination about whether to cover a particular service on a MAC-wide basis.

As we noted, the lengthy meeting included commentary from 50-plus RPM and RTM subject matter experts, mostly physicians from various specialties with remote care management experience. These physicians spoke passionately about the value and importance of RPM and RTM. Their insight and patient stories undoubtedly helped convince the two meeting hosts — Novitas and First Coast — to put their new LCD plans on hold, thus avoiding potential new restrictions on RPM and RTM.

This is welcome news, but the announcement does not preclude these or the other five MACs from developing RPM and RTM LCDs in the future. As the Connected Health Initiative states in its statement about the LCD decision, "While today's development is positive, much more work remains to be done to ensure that policy decisions impacting digital health are made by other MACs, the Centers for Medicare & Medicaid Services, Medicaid authorities, and Congress."

At Prevounce, we will continue serving as advocates for RPM and RTM and support initiatives that will help expand access to these valuable services. Our efforts will include further compiling evidence to support the clinical utility of RPM and RTM and working with our provider partners to publish and distribute this data.

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