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H.R. 3635 · 115th Congress

Local Coverage Determination Clarification Act of 2017

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IntroducedPassed one chamberPassed both chambersBecame law (gold)Resolution agreed to (full, dark)Failed or vetoed (gray)

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Passed the House without a recorded vote, then expired. It passed by voice vote or unanimous consent, which don't record how each member voted, but didn't become law before the 115th Congress ended.

LJR JenkinsSponsor
81 cosponsors · 33 D, 48 R
RKD Kind PMR Meehan PSR Sessions JCD Crowley MMR Mullin CPD Peterson EED Engel KMR Marchant SMD Moulton TSD Sewell PTD Tonko FUR Upton DLD Loebsack BRD Rush JSD Schakowsky PRR Roe SSR Stivers EBD Blumenauer DDD DeGette BBD Boyle GBR Bilirakis RCR Costello BCR Carter ASR Scott DSR Schweikert MDD Doyle AKD Kuster SDR DesJarlais MBR Bishop AHR Harris DMD Matsui MTD Thompson TCD Cárdenas CCR Curbelo GHR Harper RMR Marshall DYR Young LLR Lance BFR Flores MBR Blackburn JMD McNerney AFR Ferguson RRD Ruiz SMD Maloney EPR Paulsen DKR Kustoff SPD Peters RKD Khanna MKR Kelly GKD Butterfield DBR Black YCD Clarke PCR Cook END Norton TWR Walberg CRD Ruppersberger GTR Thompson STR Tipton PDD DeFazio KRD Rice KCR Cramer JKD Kennedy BWR Wenstrup JHR Herrera Beutler ABR Biggs BHR Huizenga WHR Hurd RCR Crawford ASR Smith BTD Thompson BWR Westerman DLR Lesko BBR Byrne EJD Johnson JDR Duncan DBR Brat ECD Cleaver BPR Poliquin NDR Dunn JRR Renacci MCR Coffman

1 signed on when it was introduced; the rest joined later. Cosponsors who withdrew aren't shown.

  1. House Introduced Aug 1, 2017
  2. House Passed Sep 12, 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.

What it does: CRS summary · Introduced in House · Aug 1, 2017

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.

Written by the nonpartisan Congressional Research Service. All summary versions on Congress.gov

About this bill and sources

Official title: Local Coverage Determination Clarification Act of 2018

Latest action (Sep 17, 2018): Received in the Senate and Read twice and referred to the Committee on Finance.

Policy area: Health · Origin: House · Introduced: Aug 1, 2017

Official page on Congress.gov · Bill text (GovInfo) · Status record (XML)

  1. House Introduced Aug 1, 2017
  2. House Passed Sep 12, 2018

No recorded floor vote found.