Luján, Cotton Introduce Bipartisan Legislation to Improve Medicare Patients’ Access to Timely, Necessary Care

Washington, D.C. – Today, U.S. Senators Ben Ray Luján (D-N.M.) and Tom Cotton (R-Ark.) introduced the Timely Access to Coverage Decisions Act, legislation to improve Medicare patients’ access to timely and medically necessary care by making the Medicare coverage determination process more predictable, transparent, and rooted in medical evidence. National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) are the Medicare policies that determine whether specific medical services, procedures, and devices are considered reasonable and necessary for coverage within a Medicare Administrative Contractor’s (MAC) jurisdiction. The current process for issuing and updating coverage decisions can result in lengthy delays and uncertainty for patients and providers, even as medical evidence and technology continue to advance. By establishing clearer timelines, increasing transparency, and improving oversight, the Timely Access to Coverage Decisions Act would help ensure Medicare patients have timely access to medically necessary items and services. “Medicare beneficiaries should not have to wait years for cutting edge treatments while medical science and technology advance rapidly,” said Senator Luján . “Patients deserve a coverage process that is timely, transparent, and informed by qualified health experts. My Timely Access to Coverage Decisions Act will bring greater accountability and certainty to Medicare coverage decisions so patients can access the care they need without unnecessary delays.” “Arkansas seniors deserve access to high-quality medical treatments, and they shouldn’t have to wait on the slow clock of government to obtain coverage for them. Our bill would require Medicare administrators to give seniors prompt, transparent decisions about their coverage, ensuring they can address their health concerns in a timely manner,” said Senator Cotton . Specifically, the Timely Access to Coverage Decisions Act would: Establish a predictable timeframe for coverage decisions : Medicare Administrative Contractors would be required to determine whether formal LCD requests and reconsideration requests are complete within 60 days. Increase transparency in the coverage decision process : Medicare Administrative Contractors would be required to hold public meetings on proposed LCDs, provide advance notice of meeting agendas, seek input from an expert panel that includes patients, physicians, and industry stakeholders, and make meeting records publicly available. Ensure logical outgrowth of draft LCDs : Final LCDs would be required to be a logical outgrowth of the draft LCD. Any updates to an LCD that are not a logical outgrowth of the draft must be reissued as a draft LCD before finalization. Strengthening oversight of Medicare coverage decisions : Would provide for additional review by the Centers for Medicare & Medicaid Services following the completion of certain reconsideration requests. “Patients should not face delays in care because Medicare coverage decisions are developed through processes that lack transparency, consistency, or meaningful stakeholder input,” said Dr. Zhai, College of American Pathologists . “Local Coverage Determinations play an important role in ensuring access to medically necessary services, and it is critical that these policies are based on clear evidence and informed by practicing physicians and patients. This legislation represents an important step toward improving the LCD process by strengthening transparency, increasing accountability, and creating more opportunities for stakeholder engagement. These reforms will help ensure coverage decisions are made through a fair, predictable, and evidence-based process. We commend the bipartisan Senate sponsors for advancing this legislation and for recognizing the importance of timely, transparent coverage policies that support patient access to medically necessary care.” “Medicare beneficiaries should not have to wait months or years for a decision on whether they can access a technology or service that may be medically necessary to maintain their health, mobility, independence, and quality of life. Timely, transparent, and accountable coverage decisions are essential to a Medicare program that keeps pace with advances in technology and the needs of beneficiaries. The ITEM Coalition commends Senators Luján and Cotton for recognizing that timely access to Medicare coverage is not simply an administrative issue; it is fundamental to ensuring that beneficiaries can access the care and technologies they need,” said Michael Barnett, J.D., ITEM Coalition Co-Coordinator. “The American Podiatric Medical Association (APMA) commends Senators Luján and Cotton for their bipartisan leadership on the Timely Access to Coverage Decisions Act. Medicare beneficiaries and their physicians deserve timely, transparent, and evidence-based coverage decisions. This legislation would establish clearer timelines for coverage decisions and ensure physicians and other stakeholders have meaningful opportunities to provide input throughout Medicare’s Local Coverage Determination process,” said Patrick A. DeHeer, DPM, APMA President. “Timely Medicare coverage is critical to ensuring patients can benefit from the latest lifesaving, life-changing medtech,” said Scott Whitaker, president and CEO of AdvaMed, the medtech association . “By setting clear expectations for Local Coverage Determination reviews and strengthening transparency and accountability, the Timely Access to Coverage Decisions Act would help reduce unnecessary delays and make the process more predictable for patients, providers, and innovators. AdvaMed strongly supports this bipartisan legislation and thanks Senators Luján and Cotton and Representatives Dunn, Tenney, Barragán, and Foushee for their leadership.” Full text of the legislation is available here . ###