Improving Timely Access to Medicare Coverage Decisions

Delays in Medicare coverage decisions can delay diagnosis and treatment. The Timely Access to Coverage Decisions Act would help ensure that patients receive medically necessary care when they need it.

Coverage decisions can be slow, inconsistent, and unclear. These gaps can delay access to diagnostic tests and treatments, or limit coverage altogether.

What's Happening

Medicare coverage decisions play a critical role in whether patients can access diagnostic tests and treatments. Local Coverage Determinations (LCDs) help shape access to care at the regional level, but the current process often lacks consistency, transparency, and timely decision-making. The results?

• Delayed care
• Confusing coverage decisions
• Limited patient and physician input
• No clear way to appeal

The Impact

Patients and physicians rely on clear and timely coverage decisions. When those decisions are unclear or delayed, access to necessary testing and treatment can be affected. Delays in coverage can mean delayed diagnoses and delayed treatment decisions—and can even result in patients going without needed care.

The Solution 

The Timely Access to Coverage Decisions Act (H.R. 8500) is bipartisan legislation introduced in the House that would improve the coverage process by strengthening transparency, accountability, and timeliness, helping ensure more prompt and predictable access to medically necessary care.

What This Bill Does

The legislation strengthens the LCD process by:

• Establishing clearer timelines for coverage decisions
• Increasing transparency into how decisions are made
• Ensuring meaningful input from physicians and patients

Patients can’t wait for medically necessary care. 
Tell Congress: Patients deserve timely access to care.

• LCD issue brief
• LCD supplemental reading
• Case examples of impact
• CAP statement on LCD reform