Timely Access to Coverage Decisions Act of 2026
- Bill Number
- H.R. 8500
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-04-27: 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.
- Last Updated
- 2026-05-19T20:20:40Z
AI-Generated Summary
Purpose
The Timely Access to Coverage Decisions Act of 2026 (H.R. 8500) aims to speed up and make more transparent the process for reviewing local coverage determinations (LCDs) under Medicare. LCDs are regional decisions by Medicare contractors on whether specific medical items or services (like tests or treatments) are covered by Medicare in a particular geographic area.
Key Provisions
- Timelines for Formal LCD Requests (new rule effective 90 days after enactment):
- Medicare Administrative Contractors (MACs)—private companies handling Medicare claims regionally—must decide within 60 days if a formal LCD request is complete or incomplete.
- If incomplete, notify the requester in writing within 60 days, listing needed information.
- If complete, issue a decision within 1 year, following existing development steps (like public notice and rationale).
- Timelines for Formal Reconsideration Requests (similar process):
- Applies to requests to rethink a finalized LCD by "interested parties" (e.g., Medicare beneficiaries, providers, or suppliers in the area).
- Same 60-day completeness check and 1-year decision timeline for complete requests.
- Secretary of Health and Human Services Review:
- Allows interested parties to request review of a reconsideration decision if it misapplies evidence, exceeds scope, is incorrect on medical necessity, lacks clear conditions, misapplies to items/services, or conflicts with other rules/national decisions.
- Enhanced Development Process for Specified LCDs (new or major revisions):
- Publish draft LCD online (on Medicare Coverage Database and MAC site) with rationale and evidence.
- Hold public meetings (remote access) within 60 days, get expert panel input (doctors, advisors, patient advocates), post meeting records.
- Allow at least 30 days for written public comments.
- Post final version responding to comments, with effective date at least 45 days later; must be a "logical outgrowth" (natural extension) of the draft.
- Effective Date: Applies 1 year after enactment.
Significant Changes to Existing Law
- Introduces mandatory timelines (60 days for completeness, 1 year for decisions) where previously none existed for formal LCD and reconsideration requests.
- Expands transparency: Requires public drafts, meetings, expert input, full comment responses, and posted records—revising the prior process under Social Security Act §1862(l)(5)(D).
- Adds Secretary-level review of reconsiderations and defines "specified LCDs" (new, substantive changes, or Secretary-designated).
- Emphasizes "qualifying evidence" (peer-reviewed research, guidelines) for decisions.
Potential Impacts
- Government Agencies: Increases workload for MACs (more meetings, postings) and Centers for Medicare & Medicaid Services (CMS) oversight; may reduce delays in coverage decisions.
- Citizens (Medicare Beneficiaries): Faster access to coverage clarity for treatments; more public input reduces arbitrary denials.
- Providers/Suppliers: Quicker LCD processes aid billing and service planning; reconsideration rights strengthen appeals.
- No direct international relations impact.
Main Stakeholders Affected
- Medicare beneficiaries (65+ seniors, disabled individuals).
- Healthcare providers/suppliers (doctors, hospitals, device makers furnishing covered services).
- MACs (must meet new deadlines and transparency rules).
- CMS/Secretary (reviews reconsiderations, hosts database).
- Patient advocates and medical experts (input via panels/comments).
Notable Legal, Constitutional, or Political Implications
- Legal: Enhances due process by mandating notice, public input, and evidence-based reviews, aligning with Medicare's "reasonable and necessary" standard (§1862(a)(1)(A)).
- Constitutional: Supports fair administrative procedures without raising takings or equal protection issues.
- Political: Bipartisan sponsors (Dunn, Barragan, Tenney); promotes accountability in Medicare (serving 65M+), potentially reducing litigation over coverage denials while adding bureaucracy. No major funding changes specified.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (2)
Rep. Barragán, Nanette Diaz [D-CA-44], Rep. Tenney, Claudia [R-NY-24]
Recent Actions
- 2026-04-27: 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.
- 2026-04-27: 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.
- 2026-04-27: Introduced in House
- 2026-04-27: Introduced in House
Bill Versions
- Timely Access to Coverage Decisions Act of 2026 — issued 2026-04-27 — PDF (14 pages)