“A bill to amend title XVIII of the Social Security Act to ensure timely review of local coverage determination requests under the Medicare program.”
No CRS summary available for this bill.
This section requires Medicare administrative contractors to determine within 60 days whether formal local coverage determination (LCD) requests received on or after 90 days after enactment are complete or incomplete, notify submitters of any deficiencies if incomplete, and issue decisions on complete requests within 1 year. It applies the same 60-day completeness review and 1-year decision timelines to formal reconsideration requests, defines interested parties eligible to submit such requests, and directs the Secretary to review contractor reconsideration decisions upon request by an interested party on specified grounds including misapplication of evidence or incorrect reasonable-and-necessary determinations.