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.
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:
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:
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.
Referred to the Subcommittee on Health.
Introduced in Senate
Read twice and referred to the Committee on Finance.
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