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119-s-5475119th CongressWALLET

Timely Access to Coverage Decisions Act

Sponsored By: Senator Luján, Ben Ray [D-NM]

Introduced

Summary

The Timely Access to Coverage Decisions Act would require new deadlines, public drafts, expert input, and a review path so Medicare local coverage determinations are more timely and transparent. It focuses on structured development, set timelines for requests and reconsiderations, and a Secretary review option for disputed final decisions.

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  • Medicare beneficiaries: Would get clearer notice and more opportunity to weigh in because draft local coverage determinations must be published with rationale and evidence and include public meetings and a comment period.
  • Providers and suppliers: Would face a formal request and reconsideration process that sets a 60‑day completeness check and requires substantive action within 1 year after a complete request. These steps apply to requests received after specified post‑enactment windows.
  • Medicare administrative contractors and stakeholders: Would need to run open meetings, assemble expert panels, post meeting records within 14 days, allow at least a 30‑day public comment period, and delay final rules at least 45 days after posting.

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

Faster decisions for Medicare coverage requests

If enacted, Medicare contractors would have 60 days to decide whether a formal local coverage determination or formal reconsideration request is complete. These completeness rules would apply to requests received on or after 90 days after enactment. If a request is incomplete, the contractor would have to send written notice within 60 days listing the missing information. For complete requests, the contractor would have to do the full development process (draft, expert input, public meetings, and comments) and finalize the LCD within 1 year of receipt. Most other parts of the section would start 1 year after enactment.

More public and Secretary review of Medicare rules

If enacted, contractors would have to post drafts of certain local coverage decisions on the Medicare Coverage Database with coding guidance, a written rationale, and evidence. Within 60 days of posting a draft they would hold public meetings, post agendas at least 14 days beforehand, and post meeting records within 14 days. After records are posted there would be at least 30 days for written public comments. Final decisions would have to explain the rationale, include any qualifying evidence not previously described, be a logical outgrowth of the draft, and not take effect until at least 45 days after posting. After a complete formal reconsideration, an interested party could ask the HHS Secretary to review the final determination for specified errors or conflicts.

Sponsors & CoSponsors

Sponsor

Luján, Ben Ray [D-NM]

NM • D

Cosponsors

  • Sen. Cotton, Tom [R-AR]

    AR • R

    Sponsored 9/23/2026

Roll Call Votes

No roll call votes available for this bill.

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