Timely Access to Coverage Decisions Act of 2026

Key Points

• The bill sets a strict 60-day deadline for Medicare contractors to review whether a request for local coverage is complete or incomplete. If incomplete, the contractor must spell out exactly what additional information is needed within that same 60-day window.
• Once a request is deemed complete, the contractor must make a final coverage decision within one year. This applies to both new local coverage determination (LCD) requests and reconsideration requests for existing coverage decisions.
• The bill requires contractors to hold public meetings, seek input from expert panels including doctors and patient advocates, and allow at least 30 days for written public comments before any new or revised local coverage determination can take effect.
• If a coverage decision is denied after reconsideration, patients, providers, and other interested parties can request a Secretary-level review. The review checks whether the contractor misapplied medical evidence, exceeded its scope, or conflicted with other laws or national coverage determinations.
• The new rules would take effect one year after the bill is signed into law. The 90-day implementation window for contractors to begin following the new timelines starts after that effective date.

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Related Bills

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