Revising the local coverage determination process under the Medicare program

(a) In general Section 1862(l)(5) of the Social Security Act (42 U.S.C. 1395y(l)(5)) is amended— (1) in subparagraph (D), by adding at the end the following new clauses: (vi) Identification of any medical or scientific experts whose advice was obtained by such contractor during the development of such determination, whether or not such contractor relied on such advice in developing such determination. (vii) A hyperlink to any written communication between such contractor and another entity that such contractor relied on when developing such determination. (viii) A hyperlink to any rule, guideline, protocol, or other criterion that such contractor relied on when developing such determination.; and (2) by adding at the end the following new subparagraphs: (E) Prohibition on imposition of practitioner qualifications The Secretary shall prohibit a Medicare administrative contractor that develops a local coverage determination from imposing such determination on any coverage limitation with respect to the qualifications of a physician (as defined in section 1861(r)) or a practitioner described in section 1842(b)(18)(C) who may furnish the item or service that is the subject of such determination. (F) Civil monetary penalty A Medicare administrative contractor that develops a local coverage determination that fails to make information described in subparagraph (D) available as required by the Secretary under such subparagraph or comply with the prohibition under subparagraph (E) is subject to a civil monetary penalty of not more than $10,000 for each such failure. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).. (b) Timing of review Section 1869(f)(2) of the Social Security Act (42 U.S.C. 1395ff(f)(2)) is amended by adding at the end the following new subparagraph: (D) Timing of review An aggrieved party may file a complaint described in subparagraph (A) with respect to a local coverage determination on or after the date that such determination is posted, in accordance with section 1862(l)(5)(D), on the Internet website of the Medicare administrative contractor making such determination, whether or not such determination has taken effect.. (c) Effective date The amendments made by this section shall apply to local coverage determinations made available on the internet website of a Medicare administrative contractor and on the Medicare internet website on or after the date of the enactment of this Act.