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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5392 Introduced in House (IH)]

<DOC>

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Timely Access to Coverage Decisions 
Act of 2023''.

SEC. 2. ENSURING TIMELY REVIEW OF LOCAL COVERAGE DETERMINATION REQUESTS 
              UNDER THE MEDICARE PROGRAM.

    Section 1862(l)(5) of the Social Security Act (42 U.S.C. 
1395y(l)(5)) is amended by adding at the end the following new 
subparagraph:
                    ``(E) Timeframe for decisions on requests for local 
                coverage determinations.--
                            ``(i) In general.--The Secretary shall 
                        require each Medicare administrative contractor 
                        that receives a document that identifies itself 
                        as a request for a local coverage determination 
                        on or after the date that is 90 days after the 
                        date of the enactment of this subparagraph to 
                        determine whether such request is a complete 
                        request or an incomplete request not later than 
                        30 days after such contractor receives such 
                        document.
                            ``(ii) Notification with respect to 
                        incomplete requests.--In the case a Medicare 
                        administrative contractor makes a determination 
                        described in clause (i) with respect to a 
                        document so described that such document is an 
                        incomplete request for a local coverage 
                        determination, not later than 60 days after the 
                        date on which such contractor received such 
                        document, such contractor shall transmit to the 
                        entity that submitted such document a 
                        notification of such determination that 
                        includes a specification of each item of 
                        additional information needed to make such 
                        document a complete request for a local 
                        coverage determination.
                            ``(iii) Decision timeline for complete 
                        requests.--In the case a Medicare 
                        administrative contractor makes a determination 
                        described in clause (i) with respect to a 
                        document so described that such document is an 
                        complete request for a local coverage 
                        determination, not later than 9 months after 
                        the date on which such contractor received such 
                        document, such contractor shall--
                                    ``(I) complete any necessary 
                                research relating to such request;
                                    ``(II) consult with outside experts 
                                on such request;
                                    ``(III) undertake a 45-day public 
                                comment period on such request; and
                                    ``(IV) issue a decisions with 
                                respect to such request.''.
                                 <all>
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