I 118th CONGRESS 1st Session H. R. 5389 IN THE HOUSE OF REPRESENTATIVES September 12, 2023 Mr. Guthrie (for himself and Mr. Kelly of Pennsylvania ) 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 transparency in the national coverage determination process under the Medicare program.

1. Short title This Act may be cited as the National Coverage Determination Transparency Act . 2. Ensuring transparency in the national coverage determination process under the Medicare program (a) In general Section 1862(l) of the Social Security Act ( 42 U.S.C. 1395y(l) ) is amended by adding at the end the following new paragraphs: (7) Transparency in national coverage determinations (A) In general With respect to each document (whether physical or electronic) received by the Secretary on or after the date that is 30 days after the date of the enactment of this paragraph that identifies itself as a request for a national coverage determination, the Secretary shall, not later than 30 calendar days after receipt of such document— (i) determine whether such document is a complete, formal request for a national coverage determination (as described in the rule entitled Medicare Program; Revised Process for Making National Coverage Determinations (78 Fed. Reg. 48164) or a successor regulation); and (ii) in the case that the Secretary finds that such document is not a complete, formal request for a national coverage determination, directly transmit to the entity submitting such document an explanation of such finding that includes a specification of each item of additional information needed to make such document a complete, formal request for a national coverage determination. (B) Resubmission of document (i) In general In the case of a document described in subparagraph (A) with respect to which the Secretary has made a finding described in clause (ii) of such subparagraph, the entity submitting such document may submit to the Secretary a revised document that includes the additional information specified in such clause with respect to such document. Such revised document shall be treated as a newly-received document for purposes of subparagraph (A). (ii) Technical assistance The Secretary shall provide such technical assistance as is practicable in order to assist entities in submitting revised documents under clause (i). (C) Publication The Secretary shall make available on a publicly accessible website of the Centers for Medicare & Medicaid Services or other appropriate means each document that the Secretary has determined is a complete, formal request for a national coverage determination (as described in subparagraph (A)(i)) not later than 2 business days after the date of such determination. (8) Clarification on timing requirements for national coverage determinations For purposes of paragraphs (2) and (3) and with respect to a request for a national coverage determination received on or after the date that is 30 days after the date of the enactment of this paragraph, the references to the date of the request and the date the request is made shall be treated as references to the date the request was received by the Secretary, regardless of whether the Secretary had determined that such request was a complete, formal request (as described in paragraph (7)(B)(i)) as of such date. . (b) Inclusion of certain time periods in annual reports Section 1869(f)(7)(A) of the Social Security Act ( 42 U.S.C. 1395ff(f)(7)(A) ) is amended by adding at the end the following new sentence: Each such report submitted on or after the date that is 30 days after the date of the enactment of this sentence shall include in such actual time periods with respect to such a request any intervening time between the receipt of such request by the Secretary and the Secretary’s determination that such request was a complete, formal request (as described in section 1861(l)(7)(B)(i)). .