IN THE SENATE OF THE UNITED STATES
March 17, 2016
Mr. Thune (for himself, Ms. Heitkamp, Mr. Roberts, Mr. Crapo, Mr. Rounds, Mrs. Capito, Mr. Grassley, Mr. Manchin, Mr. Daines, Mr. Barrasso, Mr. Cochran, Ms. Hirono, Mr. Bennet, Mrs. Ernst, Mr. King, and Mr. Tester) introduced the following bill; which was read twice and referred to the Committee on Finance
To improve access to durable medical equipment for Medicare beneficiaries under the Medicare program, and for other purposes.
This Act may be cited as the
Patient Access to Durable Medical Equipment Act of 2016.
Extension of the transition to new payment rates for durable medical equipment under the Medicare program
The Secretary of Health and Human Services shall extend the transition period described in clause (i) of section 414.210(g)(9) of title 42, Code of Federal Regulations, from June 30, 2016, to September 30, 2017 (with the full implementation described in clause (ii) of such section applying to items and services furnished with dates of service on or after October 1, 2017).
Bid ceiling for competitive acquisition for durable medical equipment under the Medicare program
Section 1847(b)(5) of the Social Security Act (42 U.S.C. 1395w–3(b)(5)) is amended—
in subparagraph (A)—
, subject to subparagraph (E), after
subsection (a)(2); and
, subject to subparagraph (E), after
Based on such bids; and
by adding at the end the following new subparagraph:
Bid ceiling for durable medical equipment
The ceiling for a bid submitted for applicable covered items may not be less than the fee schedule amount that would otherwise be determined for such items under section 1834(a), section 1834(h), or section 1842(s)(1) on January 1, 2015, updated by the covered item update for such items under section 1834(a)(14)(L), section 1834(h), or section 1842(s)(1), respectively, as appropriate for the year with respect to which the bid ceiling is established for such applicable covered item.
Application to new covered items
The Secretary shall establish a process for purposes of applying clause (i) with respect to applicable covered items for which no fee schedule amount would otherwise be paid under section 1834(a), section 1834(h), or section 1842(s), as appropriate, on January 1, 2015.
Applicable covered items defined
For purposes of this subparagraph, the term
applicable covered items means competitively priced items and services described in subsection (a)(2) that are furnished with respect to rounds of competition that begin on or after January 1, 2017.
Requirements in determining adjustments using information from competitive bidding programs
Section 1834(a)(1)(G) of the Social Security Act (42 U.S.C. 1395m(a)(1)(G)) is amended by adding at the end the following new sentence: “In the case of items and services furnished on or after January 1, 2019, in making any adjustments under clause (ii) or (iii) of subparagraph (F), the Secretary shall—
solicit and take into account stakeholder input; and
take into account the highest amount bid by a winning supplier in a competitive acquisition area and a comparison of each of the following with respect non-competitive acquisition areas and competitive acquisition areas:
The average travel distance and cost associated with furnishing items and services in the area.
Any barriers to access for items and services in the area.
The average delivery time in furnishing items and services in the area.
The average volume of items and services furnished by suppliers in the area.
The number of suppliers in the area.
Monthly report on the results of the monitoring of access of Medicare beneficiaries to durable medical equipment and of health outcomes
Not later than the first of each month (beginning with May 1, 2016, and ending with September 1, 2017), the Secretary of Health and Human Services shall publish on the Internet website of the Centers for Medicare & Medicaid Services the results of the monitoring of access of Medicare beneficiaries to durable medical equipment and of health outcomes, as described on page 66228 in the final rule published by the Center for Medicare & Medicaid Services on November 6, 2014, and entitled
Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (79 Fed. Reg. 66120–66265).
Revision of effective date of provision limiting Federal Medicaid reimbursement to States for durable medical equipment (DME) to Medicare payment rates
Section 1903(i)(27) of the Social Security Act (42 U.S.C. 1396b(i)(27)) is amended by striking
January 1, 2019 and inserting
October 1, 2018.
The amendment made by subsection (a) shall take effect as if included in the enactment of section 503 of division O of Public Law 114–113.