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H.R. 3635

Local Coverage Determination Clarification Act of 2018

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.

Received in the Senate and Read twice and referred to the Committee on Finance.

Rep. Jenkins, Lynn [R-KS-2](R-KS)Sponsor
81 cosponsors33 D48 R
81cosponsors3committees19actions1related bills6subjects
  1. IntroReferral

    Received in the Senate and Read twice and referred to the Committee on Finance.

    Finance Committee
  2. FloorH38310

    Motion to reconsider laid on the table Agreed to without objection.

  3. FloorH37300

    On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H8122-8124)

  4. Floor8000

    Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote.(text: CR H8122-8124)

  5. FloorH8D000

    DEBATE - The House proceeded with forty minutes of debate on H.R. 3635.

  6. FloorH30000

    Considered under suspension of the rules. (consideration: CR H8122-8124)

  7. FloorH30300

    Ms. Jenkins (KS) moved to suspend the rules and pass the bill, as amended.

  8. CalendarsH12410

    Placed on the Union Calendar, Calendar No. 724.

  9. DischargeH12300

    Committee on Energy and Commerce discharged.

    Energy and Commerce Committee
  10. Committee5500

    Committee on Energy and Commerce discharged.

    Energy and Commerce Committee
  11. CommitteeH12200

    Reported (Amended) by the Committee on Ways and Means. H. Rept. 115-933, Part I.

    Ways and Means Committee
  12. Committee5000

    Reported (Amended) by the Committee on Ways and Means. H. Rept. 115-933, Part I.

    Ways and Means Committee
  13. Committee

    Ordered to be Reported in the Nature of a Substitute by Voice Vote.

    Ways and Means Committee
  14. Committee

    Committee Consideration and Mark-up Session Held.

    Ways and Means Committee
  15. Committee

    Referred to the Subcommittee on Health.

    Health Subcommittee
  16. IntroReferralH11100

    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.

    Energy and Commerce Committee
  17. IntroReferralH11100

    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.

    Ways and Means Committee
  18. IntroReferralIntro-H

    Introduced in House

  19. IntroReferral1000

    Introduced in House

Local Coverage Determination Clarification Act of 2018 — Informed