H.R. 8500: Timely Access to Coverage Decisions Act of 2026

This bill, known as the Timely Access to Coverage Decisions Act of 2026, aims to amend the Social Security Act to ensure that decisions regarding local coverage determinations (LCDs) under the Medicare program are made in a timely manner. It establishes specific timeframes for Medicare administrative contractors regarding how they assess and notify requests for local coverage determinations and reconsiderations.

Key Provisions

• Timeframe for Local Coverage Determination Requests:
  • If a request is deemed incomplete, the contractor must notify the requesting entity in writing about what additional information is needed, also within 60 days.
  • If the request is complete, the contractor has up to one year to provide a decision about the local coverage determination.
• Timeframe for Reconsideration Requests:
  • Contractors must notify requestors of any deficiencies in these requests within the same 60-day timeframe.
  • For complete reconsideration requests, a decision must be made within one year after receipt.
• Review of Determinations:
• Public Involvement and Transparency:
  • They must also hold public meetings to discuss draft determinations, provide remote participation options, and maintain records of these meetings.
  • Public comments must be collected and considered prior to finalizing the determinations.
• Effective Date:
  • The provisions outlined in this bill will take effect one year after its enactment.

Relevant Companies

None found