National Coverage Determination Transparency Act

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5389 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 5389

To amend title XVIII of the Social Security Act to ensure transparency 
   in the national coverage determination process under the Medicare 
                                program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 12, 2023

Mr. Guthrie (for himself and Mr. Kelly of Pennsylvania) introduced the 
following bill; which was 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

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to ensure transparency 
   in the national coverage determination process under the Medicare 
                                program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``National Coverage Determination 
Transparency Act''.

SEC. 2. ENSURING TRANSPARENCY IN THE NATIONAL COVERAGE DETERMINATION 
              PROCESS UNDER THE MEDICARE PROGRAM.

    (a) In General.--Section 1862(l) of the Social Security Act (42 
U.S.C. 1395y(l)) is amended by adding at the end the following new 
paragraphs:
            ``(7) Transparency in national coverage determinations.--
                    ``(A) In general.--With respect to each document 
                (whether physical or electronic) received by the 
                Secretary on or after the date that is 30 days after 
                the date of the enactment of this paragraph that 
                identifies itself as a request for a national coverage 
                determination, the Secretary shall, not later than 30 
                calendar days after receipt of such document--
                            ``(i) determine whether such document is a 
                        complete, formal request for a national 
                        coverage determination (as described in the 
                        rule entitled `Medicare Program; Revised 
                        Process for Making National Coverage 
                        Determinations' (78 Fed. Reg. 48164) or a 
                        successor regulation); and
                            ``(ii) in the case that the Secretary finds 
                        that such document is not a complete, formal 
                        request for a national coverage determination, 
                        directly transmit to the entity submitting such 
                        document an explanation of such finding that 
                        includes a specification of each item of 
                        additional information needed to make such 
                        document a complete, formal request for a 
                        national coverage determination.
                    ``(B) Resubmission of document.--
                            ``(i) In general.--In the case of a 
                        document described in subparagraph (A) with 
                        respect to which the Secretary has made a 
                        finding described in clause (ii) of such 
                        subparagraph, the entity submitting such 
                        document may submit to the Secretary a revised 
                        document that includes the additional 
                        information specified in such clause with 
                        respect to such document. Such revised document 
                        shall be treated as a newly-received document 
                        for purposes of subparagraph (A).
                            ``(ii) Technical assistance.--The Secretary 
                        shall provide such technical assistance as is 
                        practicable in order to assist entities in 
                        submitting revised documents under clause (i).
                    ``(C) Publication.--The Secretary shall make 
                available on a publicly accessible website of the 
                Centers for Medicare & Medicaid Services or other 
                appropriate means each document that the Secretary has 
                determined is a complete, formal request for a national 
                coverage determination (as described in subparagraph 
                (A)(i)) not later than 2 business days after the date 
                of such determination.
            ``(8) Clarification on timing requirements for national 
        coverage determinations.--For purposes of paragraphs (2) and 
        (3) and with respect to a request for a national coverage 
        determination received on or after the date that is 30 days 
        after the date of the enactment of this paragraph, the 
        references to `the date of the request' and `the date the 
        request is made' shall be treated as references to the date the 
        request was received by the Secretary, regardless of whether 
        the Secretary had determined that such request was a complete, 
        formal request (as described in paragraph (7)(B)(i)) as of such 
        date.''.
    (b) Inclusion of Certain Time Periods in Annual Reports.--Section 
1869(f)(7)(A) of the Social Security Act (42 U.S.C. 1395ff(f)(7)(A)) is 
amended by adding at the end the following new sentence: ``Each such 
report submitted on or after the date that is 30 days after the date of 
the enactment of this sentence shall include in such actual time 
periods with respect to such a request any intervening time between the 
receipt of such request by the Secretary and the Secretary's 
determination that such request was a complete, formal request (as 
described in section 1861(l)(7)(B)(i)).''.
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