3.0.0 3392 2023-01-11T13:33:32Z 2023-01-11T13:33:32Z Senate S 2016-09-22 114 ssfi00 Finance Committee Senate Standing Referred to 2016-09-22T20:26:44Z Local Coverage Determination Clarification Act of 2016 114 5721 HR 2016-07-19 Referred to the Subcommittee on Health. Identical bill CRS 2016-09-22 ssfi00 Finance Committee Senate Read twice and referred to the Committee on Finance. IntroReferral 2016-09-22 Introduced in Senate IntroReferral 10000 9 Library of Congress I000055 Sen. Isakson, Johnny [R-GA] Johnny Isakson R GA N C000174 Sen. Carper, Thomas R. [D-DE] Thomas Carper D DE R. 2016-09-22 True K000360 Sen. Kirk, Mark Steven [R-IL] MARK KIRK R IL STEVEN 2016-09-28 False Health Administrative law and regulatory procedures Administrative remedies Department of Health and Human Services Government information and archives Medicare Public contracts and procurement Health 00 2016-09-22 Introduced in Senate 2016-10-05T11:18:50Z Local Coverage Determination Clarification Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to revise the process by which Medicare administrative contractors (MACs) issue and reconsider local coverage determinations (LCDs) that: (1) are new, (2) restrict or substantively revise existing LCDs, or (3) are otherwise specified in regulation. (MACs are private insurers that process Medicare claims within specified geographic areas.)

Before such an LCD may take effect, the MAC issuing the determination must, with respect to each geographic area to which the determination applies:

  • publish online a proposed version of the determination and other specified, related information;
  • convene one or more public meetings to review the draft determination, receive comments, and secure the advice of an expert panel;
  • post online a record of the minutes from each such meeting;
  • provide a period for submission of written public comments; and
  • post online specified information related to the rationale for the final determination.

Upon the filing of an applicable request by an interested party with regard to the reconsideration of a specified LCD, the MAC that issued the determination shall:

  • provide specified information related to whether the determination failed to correctly apply qualifying relevant evidence, exceeds the scope of its intended purpose, fails to apply as intended, or is otherwise erroneous;
  • preserve the determination, modify the determination, or rescind the determination in part; and
  • make publicly available a written description of such action.

An interested party may appeal a reconsideration decision to the Centers for Medicare & Medicaid Services (CMS).

CMS shall appoint a Medicare Reviews and Appeals Ombudsman to carry out specified duties with regard to LCDs.

]]> Local Coverage Determination Clarification Act of 2016 Display Title Local Coverage Determination Clarification Act of 2016 Official Title as Introduced A bill to amend title XVIII of the Social Security Act in order to improve the process whereby Medicare Administrative Contractors issue local coverage determinations under the Medicare Program, and for other purposes. Introduced in Senate IS Short Titles as Introduced Local Coverage Determination Clarification Act of 2016 Introduced in Senate 2016-09-22T04:00:00Z https://www.govinfo.gov/content/pkg/BILLS-114s3392is/xml/BILLS-114s3392is.xml 2016-09-22 Read twice and referred to the Committee on Finance. 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. Congressional Research Service, Library of Congress This file contains bill summaries and statuses for federal legislation. A bill summary describes the most significant provisions of a piece of legislation and details the effects the legislative text may have on current law and federal programs. Bill summaries are authored by the Congressional Research Service (CRS) of the Library of Congress. As stated in Public Law 91-510 (2 USC 166 (d)(6)), one of the duties of CRS is "to prepare summaries and digests of bills and resolutions of a public general nature introduced in the Senate or House of Representatives". For more information, refer to the User Guide that accompanies this file.