[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5396 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 5396
To amend title XVIII of the Social Security Act to prohibit Medicare
local coverage determinations from restricting access to care, and for
other purposes.
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IN THE HOUSE OF REPRESENTATIVES
September 12, 2023
Mr. Bucshon 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 concerned
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A BILL
To amend title XVIII of the Social Security Act to prohibit Medicare
local coverage determinations from restricting access to care, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Coverage Determination Clarity Act
of 2023''.
SEC. 2. IMPROVING ACCESS TO ITEMS AND SERVICES UNDER MEDICARE LOCAL
COVERAGE DETERMINATIONS.
(a) In General.--Section 1862(l)(5) of the Social Security Act (42
U.S.C. 1395y(l)(5)) is amended--
(1) in subparagraph (A), by striking ``The Secretary'' and
inserting ``Subject to subparagraph (E), the Secretary''; and
(2) by adding at the end the following new subparagraph:
``(E) Prohibition on limiting access items and
services.--
``(i) Review of local coverage
determinations.--Beginning in 2024, and
annually thereafter, the Secretary shall review
each local coverage determination in effect as
of the date of such review to determine whether
such local coverage determination denies,
limits, or conditions the coverage or provision
of items or services beyond that provided by a
national coverage determination that has
determined that such items or services be
covered nationally under this title.
``(ii) Conflict between a national coverage
determination and a local coverage
determination.--A local coverage determination
denies, limits, or conditions the coverage or
provision of items or services for purposes of
clause (i) to the extent that such local
coverage determination limits access to such
items or services by imposing restrictions that
do not directly interpret provisions of a
national coverage determination that has
determined that such items or services be
covered nationally under this title.
``(iii) Revision of local coverage
determinations.--
``(I) In general.--If the review
conducted by the Secretary under clause
(i) determines that a local coverage
determination denies, limits, or
conditions the coverage or provision of
items or services that are approved,
cleared, authorized, or licensed under
section 505, 510(k), 513, or 515 of the
Federal Food, Drug, and Cosmetic Act or
section 351 of the Public Health
Service Act, the Secretary shall direct
the appropriate Medicare administrative
contractor to expeditiously revise such
local coverage determination to
eliminate the limitation.
``(II) Timing.--A Medicare
administrative contractor shall publish
a revised local determination no later
than the date that is 180 days after
the date on which the Secretary directs
such contractor to revise a local
coverage determination under subclause
(I).
``(iv) New local coverage determinations.--
The Secretary shall require each Medicare
administrative contractor that develops a local
coverage determination to ensure that any such
local coverage determination does not deny,
limit, or condition the coverage or provision
of items or services pursuant to clause (ii)
beyond that provided by a national coverage
determination that has determined that such
items or services be covered nationally under
this title.
``(v) Error verification and corrective
actions.--In verifying any potential errors and
taking corrective actions, Medicare
administrative contractors, comprehensive error
rate testing recovery auditors, and unified
program integrity contractors and independent
review agencies--
``(I) shall not deviate from local
coverage determination provisions
applicable in the region in which such
verification or corrective action
occurs; and
``(II) shall provide transparent
review by publishing the names of the
reviewers and their qualifications in a
place and format available to
providers.
``(vi) Reports to congress.--Beginning in
2025 and each year thereafter, the Secretary
shall submit a report to the appropriate
committees of Congress on the findings of the
review conducted under clause (i) and any local
coverage determinations revised pursuant to
clause (iii) during the preceding year.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to proposed and final local coverage determinations
posted on Medicare administrative contractor websites on and after
January 1, 2023.
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