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Titles (2)

Short Titles

Short Titles - Senate

Short Titles as Introduced

Local Coverage Determination Clarification Act of 2017

Official Titles

Official Titles - Senate

Official Titles 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.

Actions Overview (1)

Date Actions Overview
03/30/2017Introduced in Senate

All Actions (1)

Date All Actions
03/30/2017Read twice and referred to the Committee on Finance.
Action By: Senate

Cosponsors (22)

Committees (1)

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
Senate Finance03/30/2017 Referred to

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Subjects (7)

Latest Summary (1)

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Shown Here:
Introduced in Senate (03/30/2017)

Local Coverage Determination Clarification Act of 2017

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).

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