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 con-
cerned 
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 Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Timely Access to Cov-
erage Decisions Act of 2023’’. 
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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 RE-
QUESTS
FOR
LOCAL
COVERAGE
DETERMINA-
TIONS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall require each Medicare administrative 
contractor that receives a document that 
identifies itself as a request for a local cov-
erage determination on or after the date 
that is 90 days after the date of the enact-
ment 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 
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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 speci-
fication of each item of additional informa-
tion needed to make such document a com-
plete request for a local coverage deter-
mination. 
‘‘(iii) DECISION TIMELINE FOR COM-
PLETE REQUESTS.—In the case a Medicare 
administrative contractor makes a deter-
mination described in clause (i) with re-
spect 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 re-
search relating to such request; 
‘‘(II) consult with outside experts 
on such request; 
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‘‘(III) undertake a 45-day public 
comment period on such request; and 
‘‘(IV) issue a decisions with re-
spect to such request.’’. 
Æ 
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