I 

114TH CONGRESS 

1ST SESSION H. R. 3053 

To ensure appropriate coverage of ventricular assist devices under the Medicare program under title XVIII of the Social Security Act, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 14, 2015 

Mr. BUCSHON (for himself, Mr. BOUSTANY, and Ms. CLARK of Massachusetts) 

introduced the following bill; which was referred to the Committee on 

Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To ensure appropriate coverage of ventricular assist devices 

under the Medicare program under title XVIII of the 

Social Security Act, 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 ‘‘Medicare Ventricular 

5 Assist Device Access Act of 2015’’. 

6 SEC. 2. FINDINGS; PURPOSE. 

7 (a) FINDINGS.—Congress finds the following: 


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1 (1) Ventricular assistance devices are mechan2 ical blood pumps that surgeons attach to a damaged 

3 or weakened native heart to assist in pumping blood. 

4 (2) Under its coverage policy as of the date of 

5 the enactment of this Act, the Medicare program 

6 covers ventricular assist devices for Medicare bene7 ficiaries that meet certain criteria after open-heart 

8 surgery, that are approved and listed as candidates 

9 for heart transplant by a Medicare-approved heart 

10 transplant center, and for those who are not eligible 

11 for a heart transplant. 

12 (3) The Medicare program does not currently 

13 cover Medicare beneficiaries for ventricular assist de14 vices who are— 

15 (A) undergoing an evaluation to determine 

16 their candidacy for heart transplantation; or 

17 (B) potential heart transplant candidates, 

18 but who are currently not eligible for heart 

19 transplantation because of a contraindication 

20 that may be favorably modified by the use of a 

21 ventricular assist device. 

22 (4) Approximately 40 percent of patients who 

23 receive a ventricular assist device are not eligible for 

24 a heart transplant initially, but may become eligible 


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1 as the ventricular support improves their overall 

2 health. 

3 (b) PURPOSE.—The purpose of this Act is to ensure 

4 Medicare beneficiaries with heart failure have appropriate 

5 access to ventricular assist devices. 

6 SEC. 3. REVISION OF MEDICARE VENTRICULAR ASSIST DE7 VICE NATIONAL COVERAGE POLICY. 

8 (a) IN GENERAL.—Notwithstanding section 

9 1862(a)(1)(A) of the Social Security Act (42 U.S.C. 

10 1395y(a)(1)(A)) or any other provision of law, the Sec11 retary of Health and Human Services (in this section re12 ferred to as the ‘‘Secretary’’) shall revise the Medicare na13 tional coverage determination (as defined in section 

14 1869(f)(1)(B) of the Social Security Act (42 U.S.C. 

15 1395ff(f)(1)(B))) relating to coverage of ventricular assist 

16 devices to extend the coverage of such devices under title 

17 XVIII of the Social Security Act applied as of the date 

18 of the enactment of this Act with respect to individuals 

19 approved for heart transplantation to also apply to— 

20 (1) individuals who are undergoing an evalua21 tion to determine candidacy for heart transplan22 tation; and 

23 (2) individuals who would be potential heart 

24 transplant candidates, but are not so eligible because 


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1 of a contraindication that may be favorably modified 

2 by the use of a ventricular assist device. 

3 (b) CONSTRUCTION.—Nothing in this section shall be 

4 construed— 

5 (1) to limit coverage of ventricular assist de6 vices for Medicare beneficiaries who meet the Medi7 care criteria for coverage of ventricular assist devices 

8 as of the date of enactment of this Act; or 

9 (2) as preventing the Secretary from expanding 

10 its coverage decision beyond the coverage required 

11 under this section. 

12 (c) REVISION OF NATIONAL COVERAGE DECISION; 

13 EFFECTIVE DATE.— 

14 (1) REVISION OF NATIONAL COVERAGE DECI15 SION.—The Secretary shall use the processes de16 scribed in section 1862(l) of the Social Security Act 

17 (42 U.S.C. 1395y(l)) to revise its national coverage 

18 determination relating to ventricular assist devices 

19 to incorporate the requirements of this section. 

20 (2) EFFECTIVE DATE.—The revised coverage 

21 decision described in paragraph (1) shall apply to 

22 ventricular assist devices furnished on or after the 

23 date that is 30 days after the date of the enactment 

24 of this Act, regardless of the date on which the SecVerDate Sep 11 2014 06:14 Jul 15, 2015 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3053.IH H3053

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1 retary completes the process required under such 

2 paragraph. 

Æ 


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