Coverage Determination Clarity Act of 2023

This bill amends the Social Security Act to prohibit Medicare local coverage determinations from restricting access to care beyond what is allowed by national coverage determinations. It requires annual reviews of local coverage determinations and mandates revisions if they conflict with national coverage.

Sec. 2, Improving access to items and services under Medicare local coverage determinations: This section adds a new subparagraph (E) to the Social Security Act. It requires the Secretary of Health and Human Services to review each local coverage determination annually starting in 2024 to see if it denies, limits, or conditions coverage beyond what a national coverage determination allows. A local coverage determination is considered to limit access if it imposes restrictions that do not directly interpret a national coverage determination. If a review finds that a local coverage determination limits coverage for items approved by the FDA or licensed under the Public Health Service Act, the Secretary must direct the Medicare administrative contractor to revise it within 180 days. New local coverage determinations must also not limit coverage beyond national determinations. Contractors must not deviate from local coverage provisions in their region when verifying errors and must publish reviewer names and qualifications. Starting in 2025, the Secretary must submit annual reports to Congress on the review findings and any revised determinations.