DME Access and Stabilization Act of 2015

Summary: DME Access and Stabilization Act of 2015 This bill amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to modify provisions relating to payment for durable medical equipment (DME) under the Medicare and Medicaid programs. (DME includes&nbsp;certain medically necessary equipment such as walkers, wheelchairs, and hospital beds.) With respect to DME furnished in areas that are not competitive acquisition areas, current regulations require the Centers for Medicare &amp; Medicaid (CMS) to phase in, over a two-year period,&nbsp;Medicare payment adjustments using information from competitive&nbsp;acquisition programs. (Through such programs, payment amounts for each area are determined based on competitive bids submitted by suppliers, rather than&nbsp;according to an&nbsp;established fee schedule.) The bill codifies this requirement and specifies that CMS&nbsp;shall adjust fee schedule amounts to the lesser of: (1) a specified percentage of the regional amount; and (2) the amount that would otherwise be determined according to the fee schedule, with specified&nbsp;adjustments.  In determining&nbsp;Medicare payment&nbsp;adjustments for areas that are not competitive acquisition areas,&nbsp;CMS shall&nbsp;solicit stakeholder input and take into account several specified factors. CMS&nbsp;may not establish&nbsp;a ceiling on competitive bids submitted for DME that is less than the amount that would otherwise be paid under Medicare. The Medicare Beneficiary Ombudsman shall evaluate the impact of the competitive&nbsp;acquisition&nbsp;program on beneficiary health status and health outcomes. The bill limits federal Medicaid reimbursement rates to states for DME to the rates that would be paid for such items under Medicare.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``DME Access and Stabilization Act of 
2015''.

SEC. 2. REVISION OF PAYMENTS FOR DURABLE MEDICAL EQUIPMENT UNDER THE 
              MEDICARE PROGRAM.

    (a) Transition to Implementation of Fee Schedule Payment 
Adjustments Using Information From Competitive Bidding Programs.--
Section 1834(a)(1) of the Social Security Act (42 U.S.C. 1395m(a)(1)) 
is amended by adding at the end the following new subparagraph:
                    ``(J) Transition to implementation of payment 
                adjustments using information from competitive bidding 
                programs.--
                            ``(i) In general.--In implementing 
                        subparagraph (F) and paragraphs (1) and (2) of 
                        section 414.210(g) of title 42, Code of Federal 
                        Regulations with respect to items and services 
                        furnished on or after January 1, 2016, and 
                        before January 1, 2019, the fee schedule amount 
                        that would otherwise be determined for each 
                        area under this section shall be adjusted to 
                        the lesser of--
                                    ``(I) the applicable percent of the 
                                regional price determined under clause 
                                (i) of such paragraph (1) for the 
                                region in which such area is located; 
                                and
                                    ``(II) the fee schedule amount that 
                                would otherwise be determined for such 
                                area under this section on January 1, 
                                2015, updated by the covered item 
                                update described in paragraph (14)(L) 
                                for the year in which the items and 
                                services to which such fee schedule 
                                applies are furnished.
                            ``(ii) Applicable percent.--For purposes of 
                        clause (i)(I), the term `applicable percent' 
                        means--
                                    ``(I) for an area defined as a 
                                rural area for purposes of such section 
                                414.210(g) or an area in a frontier 
                                State (as defined in section 
                                1886(d)(3)(E)(iii)(II)), 130 percent; 
                                and
                                    ``(II) for any other area, 120 
                                percent.
                            ``(iii) Phase-in.--The adjustment described 
                        in clause (i) shall be implemented over a two-
                        year period and in a manner that phases in such 
                        adjustment in equal increments in each year of 
                        such two-year period, with such adjustment 
                        being fully implemented with respect to items 
                        and services furnished in 2017.''.
    (b) 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--
            (1) in subparagraph (A)--
                    (A) by inserting ``, subject to subparagraph (E),'' 
                after ``subsection (a)(2)''; and
                    (B) by inserting ``, subject to subparagraph (E),'' 
                after ``Based on such bids''; and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Bid ceiling for durable medical equipment.--
                In the case of covered items (as defined in section 
                1834(a)(13)) for which payment would otherwise be made 
                under section 1834(a) that are furnished with respect 
                to competitive bid contracts that begin on or after 
                January 1, 2019, the Secretary may not establish a 
                ceiling on bids submitted under this section for such 
                items that is less than the amount that would otherwise 
                be paid for such items under section 1834 (without the 
                application of subsection (a)(1)(F) of such section) on 
                January 1, 2015, updated by the covered item update 
                described in subsection (a)(14)(L) of such section for 
                the year in which such covered item is furnished.''.
    (c) 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 receive stakeholder input and shall also take into account the 
average travel distance and cost associated with furnishing items and 
services in a competitive acquisition area, the average volume of items 
and services furnished by providers in such an area, the clearing price 
of items and services, and the number of providers in competitive 
acquisition areas compared to the number of providers in non-
competitive acquisition areas.''.

SEC. 3. LIMITING FEDERAL MEDICAID REIMBURSEMENT TO STATES FOR DURABLE 
              MEDICAL EQUIPMENT (DME) TO MEDICARE PAYMENT RATES.

    (a) Medicaid Reimbursement.--
            (1) In general.--Section 1903(i) of the Social Security Act 
        (42 U.S.C. 1396b(i)) is amended--
                    (A) in paragraph (25), by striking ``or'' at the 
                end;
                    (B) in paragraph (26), by striking the period at 
                the end and inserting ``; or''; and
                    (C) by inserting after paragraph (26) the following 
                new paragraph:
            ``(27) with respect to any amounts expended by the State on 
        the basis of a fee schedule for items described in section 
        1861(n), as determined in the aggregate with respect to each 
        class of such items as defined by the Secretary, in excess of 
        the aggregate amount, if any, that would be paid for such items 
        within such class on a fee-for-service basis under the program 
        under part B of title XVIII, including, as applicable, under a 
        competitive acquisition program under section 1847 in an area 
        of the State.''.
            (2) Effective date.--The amendments made by this subsection 
        shall be effective with respect to payments for items furnished 
        on or after January 1, 2020.
    (b) Medicare Beneficiary Ombudsman.--Section 1808(c) of the Social 
Security Act (42 U.S.C. 1395b(c)) is amended by adding at the end the 
following new paragraph:
            ``(4) Monitoring dme reimbursement under medicaid.--The 
        Medicare Beneficiary Ombudsman shall evaluate the impact of the 
        competitive acquisition program under section 1847, including 
        as applied under section 1903(i)(27), on beneficiary health 
        status and health outcomes.''.