What does Preamble of Timely Access to Coverage Decisions Act of 2026 do?

This bill, formally titled 'To amend title XVIII of the Social Security Act to ensure timely review of local coverage determination requests under the Medicare program,' aims to modify title XVIII of the Social Security Act. The bill intends to ensure timely review of local coverage determination requests within the Medicare program.

What does SHORT TITLE. of Timely Access to Coverage Decisions Act of 2026 do?

This bill is formally titled the Timely Access to Coverage Decisions Act of 2026.

What does ENSURING TIMELY REVIEW OF LOCAL COVERAGE DETERMINATION REQUESTS of Timely Access to Coverage Decisions Act of 2026 do?

This section amends Section 1862(l)(5) of the Social Security Act to establish timeframes for decisions on local coverage determination (LCD) requests. It requires Medicare administrative contractors to determine whether a formal LCD request is complete within 60 days of receipt. If a request is incomplete, the contractor must notify the submitter within 60 days, specifying needed information. For complete requests, a decision must be made within one year of receipt. Similar timeframes are established for reconsideration requests. The Secretary may review final reconsideration decisions if an interested party requests it, analyzing factors like the application of evidence and the scope of the determination. The section also modifies the process for issuing specified LCDs, requiring publication of draft determinations, public meetings, and consideration of expert panels. It mandates posting of public comments, rationales, and qualifying evidence related to the final determination. The changes apply beginning one year after the date of enactment.

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Timely Access to Coverage Decisions Act of 2026

Last updated: 4/27/2026 · Introduced: 4/27/2026

Author: Neal Dunn (R-FL)

TL;DR (AI)

This bill establishes deadlines for Medicare administrative contractors to review and respond to local coverage determination (LCD) requests, requiring completion determinations within 60 days and final decisions within one year.
The bill mandates a more transparent LCD process, including the publication of draft determinations, public meetings, and consideration of expert panels, along with public posting of comments and rationales.
The bill allows the Secretary of Health and Human Services to review final reconsideration decisions related to LCDs if requested by an interested party, considering factors like evidence application and determination scope.

119th Congressin committeeOfficial page

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Includes provisions on preamble, short title., and 1 more.

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