Section 1 Short title
This Act may be cited as the “Timely Access to Coverage Decisions Act of 2023”.
Timely Access to Coverage Decisions Act of 2023
A BILL
To amend title XVIII of the Social Security Act to ensure timely review of local coverage determination requests under the Medicare program.
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.”