A Local Coverage Determination (LCD), as established by Section 522 of the Benefits Improvement and Protection Act, is a decision by a fiscal intermediary or carrier whether to cover a particular service on an intermediary-wide or carrier-wide basis in accordance with Section 1862(a)(1)(A) of the Social Security Act (i.e., a determination as to whether the service is reasonable and necessary).

The following end stage renal disease LCD’s are listed by fiscal intermediary and are used as a guidelines for hospice providers to determine appropriateness for hospice services before a patient is admitted to hospice care and to document a patient’s continuing appropriateness for hospice services.  Remember – these are guidelines and not regulations.  A patient may not meet all indicators within the LCD, but still be extremely appropriate to receive hospice services.  Assessment of all the patient’s needs is extremely important.

**These LCDs are applicable until the new Medicare Administrators Contracts (MAC) are released; expected late in 2009.

Cahaba LCDs

NGS LCDs

Palmetto LCDs

Resources

• The Mid-Atlantic Renal Coalition (MARC) announced the development of the brochure “Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients."

• Chronic Kidney Disease: Challenging Hospices to Assure Access; NHPCO’s Newsline Article, June 2008 

• Kidney End-of-Life Coalition Website
• ESRD Eligibility Decision Tree
• Resources on ESRD Conditions for Coverage - new resources issued by CMS, available online:
  • Frequently Asked Questions (click on the 2^nd Spotlight)
  • Crosswalk: Former Conditions versus Revised Conditions (click on the 3^rd “Spotlight”)
  • Additional Info from CMS