[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5389 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 5389
To amend title XVIII of the Social Security Act to ensure transparency
in the national coverage determination process under the Medicare
program.
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IN THE HOUSE OF REPRESENTATIVES
September 12, 2023
Mr. Guthrie (for himself and Mr. Kelly of Pennsylvania) 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 ensure transparency
in the national coverage determination process under the Medicare
program.
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 ``National Coverage Determination
Transparency Act''.
SEC. 2. ENSURING TRANSPARENCY IN THE NATIONAL COVERAGE DETERMINATION
PROCESS 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
paragraphs:
``(7) Transparency in national coverage determinations.--
``(A) In general.--With respect to each document
(whether physical or electronic) received by the
Secretary on or after the date that is 30 days after
the date of the enactment of this paragraph that
identifies itself as a request for a national coverage
determination, the Secretary shall, not later than 30
calendar days after receipt of such document--
``(i) determine whether such document is a
complete, formal request for a national
coverage determination (as described in the
rule entitled `Medicare Program; Revised
Process for Making National Coverage
Determinations' (78 Fed. Reg. 48164) or a
successor regulation); and
``(ii) in the case that the Secretary finds
that such document is not a complete, formal
request for a national coverage determination,
directly transmit to the entity submitting such
document an explanation of such finding that
includes a specification of each item of
additional information needed to make such
document a complete, formal request for a
national coverage determination.
``(B) Resubmission of document.--
``(i) In general.--In the case of a
document described in subparagraph (A) with
respect to which the Secretary has made a
finding described in clause (ii) of such
subparagraph, the entity submitting such
document may submit to the Secretary a revised
document that includes the additional
information specified in such clause with
respect to such document. Such revised document
shall be treated as a newly-received document
for purposes of subparagraph (A).
``(ii) Technical assistance.--The Secretary
shall provide such technical assistance as is
practicable in order to assist entities in
submitting revised documents under clause (i).
``(C) Publication.--The Secretary shall make
available on a publicly accessible website of the
Centers for Medicare & Medicaid Services or other
appropriate means each document that the Secretary has
determined is a complete, formal request for a national
coverage determination (as described in subparagraph
(A)(i)) not later than 2 business days after the date
of such determination.
``(8) Clarification on timing requirements for national
coverage determinations.--For purposes of paragraphs (2) and
(3) and with respect to a request for a national coverage
determination received on or after the date that is 30 days
after the date of the enactment of this paragraph, the
references to `the date of the request' and `the date the
request is made' shall be treated as references to the date the
request was received by the Secretary, regardless of whether
the Secretary had determined that such request was a complete,
formal request (as described in paragraph (7)(B)(i)) as of such
date.''.
(b) Inclusion of Certain Time Periods in Annual Reports.--Section
1869(f)(7)(A) of the Social Security Act (42 U.S.C. 1395ff(f)(7)(A)) is
amended by adding at the end the following new sentence: ``Each such
report submitted on or after the date that is 30 days after the date of
the enactment of this sentence shall include in such actual time
periods with respect to such a request any intervening time between the
receipt of such request by the Secretary and the Secretary's
determination that such request was a complete, formal request (as
described in section 1861(l)(7)(B)(i)).''.
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