ACC, SCAI Share How AUC Can Inform Medicaid Reimbursement Policies

The ACC and the Society for Cardiovascular Angiography and Interventions (SCAI) staff and members recently met with New York Department of Health (NYDOH) officials to discuss the health department's policy of using the appropriate use criteria (AUC) to inform Medicaid reimbursement policies. The policy was established as part of Governor Andrew Cuomo's Medicaid Redesign Program. During the discussion, which focused on quality improvement, patient care and physician autonomy, ACC and SCAI underscored that AUC identify myriad clinical scenarios and a personalized approach to clinical-decision making can alter the appropriateness designation. NYDOH advised they are refining their appeals process and would like input from the cardiology community moving forward. Your ACC and SCAI will continue working with the NYDOH to establish the appeals criteria, define specific areas where deference is critical, and provide additional AUC guidance. While New York is the first state to use the AUC for this purpose, ACC and SCAI are preparing to address this issue nationwide, should other states make similar recommendations for their Medicaid Redesign Programs.

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