This bill changes how Medicare local coverage determinations (LCDs) and reconsiderations are handled. It requires Medicare administrative contractors (MACs) to tell whether a formal LCD or reconsideration request is complete or incomplete within 60 days of receiving it. If a request is incomplete, the MAC must tell the requester in writing what extra information is needed. If a request is complete, the MAC must complete the review and take required actions within one year.
The bill also sets a public development process for certain important LCDs. For those LCDs, a MAC must post a draft on the Medicare Coverage Database and the MAC website, hold one or more public meetings within 60 days (with remote attendance options), get advice from an expert panel, accept public comments for at least 30 days, and post meeting records. Before a final LCD takes effect, the MAC must post responses to public comments, the full text of comments, the final rationale, any qualifying evidence considered, and set an effective date at least 45 days after posting. A final LCD must be a logical outgrowth of the draft. The bill defines qualifying evidence (peer-reviewed research, systematic reviews, evidence-based consensus statements, clinical guidelines) and defines who may submit formal reconsideration requests ("interested parties").
The Secretary must require MACs to follow the new timing rules for requests and reconsiderations starting 90 days after enactment of those rules, and the whole set of changes applies beginning 1 year after the law is enacted.
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The bill's text and title aim to ensure faster review of LCD requests and to increase transparency and public participation for certain coverage decisions. Sponsors introduced the bill to require deadlines, written notifications for missing information, and a public development process for specified LCDs.
No publicly available information.