II 

115TH CONGRESS 

1ST SESSION S. 2175 

To amend title XVIII of the Social Security Act to preserve Medicare 

beneficiary access to ventilators, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 30, 2017 

Mr. CASSIDY (for himself, Mr. MANCHIN, and Mr. GRASSLEY) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to preserve 

Medicare beneficiary access to ventilators, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Beneficiary Res5 piratory Equipment Access and Transparency to Home 

6 Ventilator Care Act of 2017’’ or the ‘‘BREATH Act of 

7 2017’’. 


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•S 2175 IS

1 SEC. 2. PROMOTING EVIDENCE-BASED CARE FOR CERTAIN 

2 VENTILATORS AND OTHER ITEMS OF DURA3 BLE MEDICAL EQUIPMENT. 

4 Section 1834 of the Social Security Act (42 U.S.C. 

5 1395m) is amended by adding at the end the following 

6 new subsection: 

7 ‘‘(v) APPROPRIATE USE CRITERIA FOR CERTAIN

8 VENTILATORS.— 

9 ‘‘(1) IN GENERAL.—Not later than January 1, 

10 2018, subject to paragraph (2), and in consultation 

11 with medical experts and applicable stakeholders, the 

12 Secretary shall establish and implement policies and 

13 standards for determining the appropriate use of 

14 ventilators as described in subsection (a)(3)(A). 

15 ‘‘(2) DELAY IN IMPLEMENTATION OF APPRO16 PRIATE USE CRITERIA FOR USE BY CERTAIN INDI17 VIDUALS.—The Secretary may, as the Secretary de18 termines appropriate, delay until such date as the 

19 Secretary determines appropriate but not later than 

20 January 1, 2020, the establishment and implementa21 tion of appropriate use criteria as described in para22 graph (1) (which may be the same appropriate use 

23 criteria established and implemented under such 

24 paragraph) for ventilators furnished to individuals 

25 diagnosed with neuromuscular or other thoracic re26 strictive diseases or cystic fibrosis.’’. 


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•S 2175 IS

1 SEC. 3. REIMBURSEMENT FOR HOME MECHANICAL VEN2 TILATORS. 

3 (a) IN GENERAL.—Section 1834(a)(3) of the Social 

4 Security Act (42 U.S.C. 1395m(a)(3)) is amended— 

5 (1) in subparagraph (B)— 

6 (A) in clause (iii), by striking ‘‘and’’ at the 

7 end; 

8 (B) in clause (iv)— 

9 (i) by inserting ‘‘, except as provided 

10 in clause (v),’’ after ‘‘subsequent year’’; 

11 and 

12 (ii) by striking the period at the end 

13 and inserting ‘‘; and’’; and 

14 (C) by adding at the end the following new 

15 clause: 

16 ‘‘(v) for an item or device furnished 

17 on or after January 1, 2018, in the case 

18 of a ventilator described in subparagraph 

19 (A), the payment rate determined for the 

20 ventilator under subparagraph (D) for the 

21 year.’’; and 

22 (2) by adding at the end the following new sub23 paragraphs: 

24 ‘‘(D) 2018 AND SUBSEQUENT YEARS PAY25 MENT RATES FOR VENTILATORS.—For purposes 

26 of subparagraph (B)(v), the payment rate deVerDate Sep 11 2014 03:32 Dec 01, 2017 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2175.IS S2175

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1 termined under this subparagraph for a venti2 lator described in subparagraph (A) is the fol3 lowing: 

4 ‘‘(i) 2018.—For 2018, the payment 

5 amount specified in subparagraph (B) for 

6 an item or device furnished on or after 

7 July 1, 2017, and before January 1, 2018, 

8 increased by the covered item update for 

9 2018. 

10 ‘‘(ii) 2019.—For 2019, the rate deter11 mined under clause (i) for 2018— 

12 ‘‘(I) increased by the covered 

13 item update for 2019; and 

14 ‘‘(II) if applicable, increased by 

15 the budget neutrality adjustment 

16 under subparagraph (E). 

17 ‘‘(iii) 2020 AND SUBSEQUENT

18 YEARS.—For 2020 and subsequent years, 

19 the rate determined under this subpara20 graph for an item or device furnished on 

21 December 31 of the previous year, in22 creased by the covered item update for the 

23 year. 


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•S 2175 IS

1 ‘‘(E) BUDGET NEUTRALITY ADJUSTMENT

2 OF PAYMENT RATES FOR VENTILATORS FOR

3 2019.— 

4 ‘‘(i) IN GENERAL.—Subject to the 

5 succeeding clauses of this subparagraph, 

6 the Secretary shall implement the provi7 sions of subparagraphs (B)(v) and (D) in 

8 a budget neutral manner and any budget 

9 neutrality adjustment under this subpara10 graph shall be limited to payments for a 

11 ventilator described in subparagraph (A) 

12 furnished during 2019. 

13 ‘‘(ii) COMPUTATION OF AGGREGATE

14 BUDGET NEUTRALITY ADJUSTMENT.—The 

15 aggregate budget neutrality adjustment 

16 under this subparagraph shall be an 

17 amount equal to the difference (if any) be18 tween— 

19 ‘‘(I) aggregate payments under 

20 this part for ventilators described in 

21 subparagraph (A) furnished during 

22 2017, as adjusted under subclause (I) 

23 of clause (iii); and 

24 ‘‘(II) aggregate payments under 

25 this part for such ventilators furVerDate Sep 11 2014 03:32 Dec 01, 2017 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2175.IS S2175

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•S 2175 IS

1 nished during 2018, as adjusted 

2 under subclause (II) of such clause. 

3 ‘‘(iii) ADJUSTMENTS.—For purposes 

4 of clause (ii)— 

5 ‘‘(I) payments described in sub6 clause (I) of such clause shall be in7 creased by the covered item update 

8 for 2018; and 

9 ‘‘(II) payments described in sub10 clause (II) of such clause shall be in11 creased or decreased by the percent12 age change in the total number of in13 dividuals enrolled under this part 

14 (other than Medicare Advantage en15 rollees) from 2017 to 2018.’’. 

Æ 


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