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H.R. 5392

BillFederalHouseIn Committee
Timely Access to Coverage Decisions Act of 2023
About This Bill
Committee
Latest Action · December 17, 2024
Referred to the Subcommittee on Health.
Congress
118th (2023–2025)
Introduced
September 12, 2023
Cosponsors (1)
0D 1R
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Summary

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This bill requires Medicare administrative contractors to process local coverage determination requests—which are requests for Medicare to cover specific medical services or treatments—on a faster timeline. Under the legislation, contractors must first determine within 30 days whether a request is complete or needs additional information, and if incomplete, must notify the requester within 60 days specifying what information is missing. For complete requests, contractors must issue a final decision within 9 months, which includes conducting research, consulting experts, and holding a 45-day public comment period. The bill affects Medicare beneficiaries, healthcare providers, and medical companies seeking coverage decisions from Medicare. The law takes effect 90 days after enactment and imposes these timeframe requirements on all Medicare administrative contractors going forward with no new federal funding specified in the text.

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