Timely Access to Coverage Decisions Act of 2026

This legislation, titled the "Timely Access to Coverage Decisions Act of 2026," aims to streamline and accelerate the review process for local coverage determinations (LCDs) and reconsideration requests within the Medicare program. It mandates that Medicare administrative contractors (MACs) must determine whether a formal LCD request or a formal reconsideration request is complete or incomplete within 60 days of receipt. If a request is incomplete, the MAC must provide a written notification to the submitter within that 60-day timeframe, detailing all necessary additional information.

For requests deemed complete, MACs are required to issue a final decision within one year of receiving the initial request. The bill also establishes a comprehensive public process for developing and finalizing specified local coverage determinations, which encompass new or substantively revised LCDs. This process includes publishing a draft determination, its rationale, and supporting evidence, followed by public meetings, a public comment period, and consultation with an expert panel. The final determination must be a "logical outgrowth" of the draft, include responses to public comments, and be posted with a detailed rationale and an effective date at least 45 days after its publication.