118 HR 8849 IH: Timeline Integrity for Medicare Evidence Development Act of 2024 U.S. House of Representatives 2024-06-26 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I118th CONGRESS2d SessionH. R. 8849IN THE HOUSE OF REPRESENTATIVESJune 26, 2024Mr. Smucker introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedA BILLTo amend title XVIII of the Social Security Act to improve the national and local coverage determination processes under the Medicare program.

1.

Short title

This Act may be cited as the Timeline Integrity for Medicare Evidence Development Act of 2024 or the TIMED Act of 2024.

2.

Improving the national and local coverage determination processes under the Medicare program

(a)

In general

Section 1862(l) of the Social Security Act (42 U.S.C. 1395y(l)) is amended by adding at the end the following new paragraph:(7)

Limitation on duration of coverage with evidence development determinations

(A)

In general

Subject to subparagraph (B), in the case of a final decision under paragraph (3)(C)(i) (including any such decision made on a class-wide basis) made on or after the date of the enactment of this paragraph that results in coverage of an item or service pursuant to subsection (a)(1)(E), the Secretary shall, not later than 10 years after the date on which such coverage becomes effective pursuant to such subsection, initiate a redetermination with respect to such item or service.(B)

Exception

The Secretary may delay a redetermination described in subparagraph (A) with respect to an item or service for a period of time determined appropriate by the Secretary if—(i)the Secretary finds that such item or service is reasonable and necessary to carry out the purposes described in section 1142; or(ii)the entity responsible for such item or service requests such extension.(C)

Posting of information

Not later than 1 year after the date of the enactment of this paragraph, and annually thereafter, the Secretary post on the public website of the Centers for Medicare & Medicaid Services the following information:(i)The number of items and services covered under this title pursuant to subsection (a)(1)(E).(ii)A description of each such item or service.(iii)The year in which coverage of each such item or service became effective pursuant to such subsection..(b)

Provision of explanation in case of certain rejected requests

Section 1862(l) of the Social Security Act (42 U.S.C. 1395y(l)), as amended by subsection (a), is further amended by adding at the end the following new paragraph:(8)

Requirement to provide explanation in case of certain rejected requests

With respect to each document received by the Secretary on or after the date that is 1 year after the date of the enactment of this paragraph that identifies itself as a complete, formal request for a national coverage determination (as described in the notice entitled Medicare Program; Revised Process for Making National Coverage Determinations (78 Fed. Reg. 48164) or a successor regulation), the Secretary shall, not later than 90 days after receipt of such document—(A)determine whether such document is a complete, formal request for a national coverage determination; and(B)in the case that the Secretary finds that such document is not a complete, formal request for a national coverage determination, transmit to the entity submitting such document information on such finding that includes a specification of additional information needed to make such document a complete, formal request for a national coverage determination..(c)

Improving access to items and services under local coverage determinations

Section 1862(l)(5) of the Social Security Act (42 U.S.C. 1395y(l)(5)) is amended by adding at the end the following new subparagraph:(E)

Ensuring consistency with applicable rules

The Secretary shall require each Medicare administrative contractor that develops a local coverage determination to ensure that any such local coverage determination does not conflict with any law, ruling, regulation, national coverage determination, payment policy, or coding policy..(d)

Funding

There are authorized to be appropriated $1,000,000 for fiscal year 2024 for purposes of carrying out the amendments made by this section.