H.R. 3635 - 115th Congress (2017-2018) - Local Coverage Determination Clarification Act of 2018

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.

Text (4)

September 17, 2018

September 12, 2018

September 10, 2018

August 1, 2017

Actions (15)

Show Only Major Actions

09/17/2018

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

09/12/2018

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

09/12/2018

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

09/12/2018

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)

09/12/2018

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

09/12/2018

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

09/12/2018

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

09/10/2018

Placed on the Union Calendar, Calendar No. 724.

09/10/2018

Committee on Energy and Commerce discharged.

09/10/2018

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

09/05/2018

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

09/05/2018

Committee Consideration and Mark-up Session Held.

08/04/2017

Referred to the Subcommittee on Health.

08/01/2017

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.

08/01/2017

Introduced in House

Public Record

Record Updated

Jan 11, 2023 1:38:50 PM