I 

114TH CONGRESS 

2D SESSION H. R. 6012 

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

beneficiary access to ventilators, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 13, 2016 

Mr. BUCSHON introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, 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 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 2016’’ or the ‘‘BREATH Act of 

7 2016’’. 


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

2 VENTILATORS AND OTHER ITEMS OF DURA3 BLE MEDICAL EQUIPMENT. 

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

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

6 new subsection: 

7 ‘‘(t) APPROPRIATE USE CRITERIA FOR CERTAIN

8 VENTILATORS.—Not later than January 1, 2017, and in 

9 consultation with medical experts, the Secretary shall es10 tablish policies and standards for determining the appro11 priate use of ventilators as described in subsection 

12 (a)(3)(A).’’. 

13 SEC. 3. REIMBURSEMENT FOR HOME MECHANICAL VEN14 TILATORS. 

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

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

17 (1) in subparagraph (B)— 

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

19 end; 

20 (B) in clause (iv)— 

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

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

23 and 

24 (ii) by striking the period at the end 

25 and inserting ‘‘; and’’; and 


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

2 clause: 

3 ‘‘(v) in 2017 and each subsequent 

4 year, in the case of a ventilator described 

5 in subparagraph (A), the payment rate de6 termined for the ventilator under subpara7 graph (D) for that year.’’; and 

8 (2) by adding at the end the following new sub9 paragraph: 

10 ‘‘(D) PAYMENT RATES FOR VENTILA11 TORS.—For purposes of subparagraph (B)(v), 

12 payment for a ventilator described in subpara13 graph (A) shall be made as follows: 

14 ‘‘(i) 2017 PAYMENT RATE.—For 

15 2017, at a rate equal to 120 percent of the 

16 rate determined under subparagraph (B) 

17 for 2016, increased by the covered item 

18 update for the year. 

19 ‘‘(ii) 2018 PAYMENT RATE.—For 

20 2018, at the rate determined under this 

21 subparagraph for 2017— 

22 ‘‘(I) increased by the covered 

23 item update for the year; 


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1 ‘‘(II) increased or decreased, ex2 pressed as a percentage, by the dif3 ference between— 

4 ‘‘(aa) the absolute percent5 age difference in the number of 

6 beneficiaries for whom the pro7 gram made payment for the rent8 al of such item or device during 

9 2017 and the number of bene10 ficiaries for whom the program 

11 made payment for the rental of 

12 the item or device during 2015; 

13 and 

14 ‘‘(bb) 20 percent; and 

15 ‘‘(III) increased or decreased by 

16 the percentage change in the total 

17 number of Medicare beneficiaries in 

18 2015 as compared to 2017. 

19 ‘‘(iii) 2019 AND SUBSEQUENT YEARS

20 PAYMENT RATE.—For 2019 and subse21 quent years, at the rate determined under 

22 this subparagraph for the previous year in23 creased by the covered item update for the 

24 year.’’. 


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1 (b) APPLICATION.—The Secretary shall implement 

2 the provisions of, and amendments made by, this section 

3 in a budget neutral manner. 

Æ 


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