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119-hr-8500119th CongressWALLET

Timely Access to Coverage Decisions Act of 2026

Sponsored By: Representative Dunn, Neal P. [R-FL-2]

Introduced

Summary

Faster, clearer Medicare local coverage decisions. This bill would require Medicare administrative contractors to meet strict deadlines for local coverage determination requests and reconsiderations, create public draft and meeting rules for major LCDs, and let the agency review reconsideration outcomes.

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  • Families and patients would get more notice and chances to weigh in on important coverage rules through public drafts, open meetings with remote access, a minimum 30-day comment period, and final rules posted at least 45 days before they take effect.
  • Providers and suppliers would face quicker formal responses and appeal paths because contractors must tell requesters if a submission is complete within 60 days and must act on complete requests within 1 year.
  • Medicare administrative contractors and CMS would follow new transparency steps for specified LCDs, including publishing drafts, meeting records, comment responses, and allowing the Secretary to review final reconsideration decisions on specified legal and evidence grounds.

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 3 benefits, 0 costs, 0 mixed.

Faster Medicare local coverage decisions

This bill would require Medicare contractors to say within 60 days whether a formal LCD or reconsideration request is complete. If a request is incomplete, the contractor would tell the sender what information is missing within 60 days. If a request is complete, the contractor would finish the required LCD steps and issue a decision within one year after receipt. The timelines and the definitions of "formal request" and "interested party" would take effect one year after enactment and apply to requests received after the 90-day cutoff described in the text.

More public review for Medicare coverage

This bill would require contractors to post draft local coverage determinations and related evidence on CMS's database and the contractor website before finalizing them. Within 60 days of posting a draft, contractors would hold open public meetings with remote options and post agendas at least 14 days ahead. Meeting records would be posted within 14 days and there would be at least 30 days for written public comment. Before a final decision takes effect, the contractor would post responses to comments, the full comments, the final rationale, any newly considered qualifying evidence, and set an effective date at least 45 days after posting.

New federal review of Medicare decisions

This bill would let an interested party ask the HHS Secretary to review a contractor's final decision after a complete formal reconsideration. The Secretary would check for misapplied qualifying evidence, language that goes beyond the intended scope, wrong findings about medical necessity, missing clinical condition descriptions, wrong application to items or services, or conflicts with other law or a national coverage decision. This review authority would take effect one year after enactment.

Sponsors & CoSponsors

Sponsor

Dunn, Neal P. [R-FL-2]

FL • R

Cosponsors

  • Rep. Barragán, Nanette Diaz [D-CA-44]

    CA • D

    Sponsored 4/27/2026

  • Rep. Tenney, Claudia [R-NY-24]

    NY • R

    Sponsored 4/27/2026

  • Rep. Foushee, Valerie P. [D-NC-4]

    NC • D

    Sponsored 7/21/2026

Roll Call Votes

No roll call votes available for this bill.

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