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Titles (2)

Short Titles

Short Titles - House of Representatives

Short Titles as Introduced

Local Coverage Determination Clarification Act of 2016

Official Titles

Official Titles - House of Representatives

Official Title as Introduced

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.

Actions Overview (1)

07/11/2016 Introduced in House

All Actions (5)

07/19/2016 Referred to the Subcommittee on Health.
Action By: Committee on Ways and Means
07/11/2016 Referred to House Energy and Commerce
Action By: House of Representatives
07/11/2016 Referred to House Ways and Means
Action By: House of Representatives
07/11/2016 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.
Action By: House of Representatives
07/11/2016 Introduced in House
Action By: House of Representatives

Committees (2)

Committees, subcommittees and links to reports associated with this bill are listed here, as well as the nature and date of committee activity and Congressional report number.

Committee / Subcommittee Date Activity Reports
House Ways and Means07/11/2016 Referred to
House Ways and Means Subcommittee on Health07/19/2016 Referred to
House Energy and Commerce07/11/2016 Referred to

Related Bills (1)

A related bill may be a companion measure, an identical bill, a procedurally-related measure, or one with text similarities. Bill relationships are identified by the House, the Senate, or CRS, and refer only to same-congress measures.

Subjects (7)

  • Administrative law and regulatory procedures
  • Administrative remedies
  • Department of Health and Human Services
  • Government information and archives
  • Medicare
  • Public contracts and procurement

Latest Summary (1)

There is one summary for H.R.5721. View summaries

Shown Here:
Introduced in House (07/11/2016)

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.