I 

118TH CONGRESS 

1ST SESSION H. R. 5392 

To amend title XVIII of the Social Security Act to ensure timely review 

of local coverage determination requests under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 12, 2023 

Mr. DUNN of Florida (for himself and Ms. TENNEY) introduced the following 

bill; which was referred to the Committee on Ways and Means, and in 

addition to the Committee on Energy and Commerce, for a period to be 

subsequently determined by the Speaker, in each case for consideration 

of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to ensure 

timely review of local coverage determination requests 

under the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Timely Access to Cov5 erage Decisions Act of 2023’’. 


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1 SEC. 2. ENSURING TIMELY REVIEW OF LOCAL COVERAGE 

2 DETERMINATION REQUESTS UNDER THE 

3 MEDICARE PROGRAM. 

4 Section 1862(l)(5) of the Social Security Act (42 

5 U.S.C. 1395y(l)(5)) is amended by adding at the end the 

6 following new subparagraph: 

7 ‘‘(E) TIMEFRAME FOR DECISIONS ON RE8 QUESTS FOR LOCAL COVERAGE DETERMINA9 TIONS.— 

10 ‘‘(i) IN GENERAL.—The Secretary 

11 shall require each Medicare administrative 

12 contractor that receives a document that 

13 identifies itself as a request for a local cov14 erage determination on or after the date 

15 that is 90 days after the date of the enact16 ment of this subparagraph to determine 

17 whether such request is a complete request 

18 or an incomplete request not later than 30 

19 days after such contractor receives such 

20 document. 

21 ‘‘(ii) NOTIFICATION WITH RESPECT

22 TO INCOMPLETE REQUESTS.—In the case a 

23 Medicare administrative contractor makes 

24 a determination described in clause (i) with 

25 respect to a document so described that 

26 such document is an incomplete request for 


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1 a local coverage determination, not later 

2 than 60 days after the date on which such 

3 contractor received such document, such 

4 contractor shall transmit to the entity that 

5 submitted such document a notification of 

6 such determination that includes a speci7 fication of each item of additional informa8 tion needed to make such document a com9 plete request for a local coverage deter10 mination. 

11 ‘‘(iii) DECISION TIMELINE FOR COM12 PLETE REQUESTS.—In the case a Medicare 

13 administrative contractor makes a deter14 mination described in clause (i) with re15 spect to a document so described that such 

16 document is an complete request for a 

17 local coverage determination, not later 

18 than 9 months after the date on which 

19 such contractor received such document, 

20 such contractor shall— 

21 ‘‘(I) complete any necessary re22 search relating to such request; 

23 ‘‘(II) consult with outside experts 

24 on such request; 


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1 ‘‘(III) undertake a 45-day public 

2 comment period on such request; and 

3 ‘‘(IV) issue a decisions with re4 spect to such request.’’. 

Æ 


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