Timely Access to Coverage Decisions Act of 2026

Predictable Timelines for Requests: Medicare administrative contractors would be required to determine if a formal local coverage determination request is complete within 60 days, providing clarity to the entity that submitted it. (Section 2(a)(i))

Clear Communication for Incomplete Submissions: If a request is deemed incomplete, the contractor must provide written notification that specifies exactly what additional information is needed, rather than leaving the applicant guessing. (Section 2(a)(ii))

Enhanced Transparency in Decision Making: The bill requires contractors to publish draft determinations, including the rationale and evidence used, on the Medicare Coverage Database and the contractor's website. (Section 2(c)(i)(I))

Increased Public Participation: The bill mandates that contractors convene open public meetings—with remote attendance options—and provide a period of at least 30 days for written public comments on draft determinations. (Section 2(c)(i)(II))

Expert Oversight: The development process requires securing advice from an expert panel that includes physicians, members of a Contractor Advisory Committee, and entities advocating for Medicare beneficiaries. (Section 2(c)(i)(II)(cc))

Accountability via Agency Review: Interested parties can request that the Secretary review a contractor's final determination to check for issues like inaccurate interpretation of evidence or incorrect determinations regarding whether a service is reasonable and necessary. (Section 2(b)(G))

Delayed Implementation of New Rules: The mandates regarding the new timeframes and processes do not take effect until one year after the bill is enacted. (Section 2(d))

Delayed Implementation of Request Deadlines: The requirement for contractors to determine if a formal local coverage determination request is complete only begins 90 days after the date of the subparagraph's enactment. (Section 2(a)(i))