In re LCD Complaint: Glucose Monitors (LCD No. L33822), DAB CR5838 (2021)

DECISION DISMISSING UNACCEPTABLE COMPLAINT

Ms. Diana Gillen filed correspondence through the mail, dated December 28, 2020, which the Civil Remedies Division (CRD) of the Departmental Appeals Board (DAB) docketed as a complaint challenging the validity of a local coverage determination (LCD).  CRD assigned the case to me for adjudication.

Based on the contents of the letter, it appeared that Ms. Gillen was acting as a representative for her mother and was challenging the LCD regarding glucose monitors.

I am required to determine if an LCD complaint is "acceptable," including whether it is "valid" under 42 C.F.R. § 426.400.  After reviewing Ms. Gillen's filing, I concluded that it was not an acceptable and valid LCD complaint.  I notified Ms. Gillen of this conclusion in an Acknowledgment of Receipt and Order to Aggrieved Party to Amend Unacceptable Complaint (Order), dated January 25, 2021.

In the Order, I advised Ms. Gillen that, while her correspondence provided information to identify the LCD being challenged, it was missing other information necessary to constitute a valid LCD complaint.  The Order stated that the Aggrieved Party had one opportunity to amend her complaint pursuant to the relevant regulation.  42 C.F.R § 426.410(c)(1).  I advised the Aggrieved Party that if she did not submit an acceptable amended complaint, then I must issue a decision dismissing the unacceptable complaint.  42 C.F.R. § 426.410(c)(2).

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My Order directed the Aggrieved Party to submit a valid amended complaint within 30 days of the date of the Order that contained the following information:

• Beneficiary-identifying information
• If Ms. Gillen is acting as her mother's representative, then a copy of a written authorization to represent her mother must be submitted
• Treating physician written statement
• Clinical or scientific evidence:  Copies of clinical or scientific evidence that support the complaint and an explanation for why the Aggrieved Party thinks that this evidence shows that the LCD is not reasonable.

I note that Ms. Gillen contacted the CRD Director and asked a few administrative questions, which he answered.  However, neither she nor the Aggrieved Party filed a response to my January 25, 2021 Order.  Thus, this complaint remains unacceptable within the terms of 42 C.F.R. § 426.410(b).  Accordingly, I dismiss the complaint.  42 C.F.R. § 426.410(c)(2).