I 

114TH CONGRESS 

2D SESSION H. R. 5210 

To improve access to durable medical equipment for Medicare beneficiaries 

under the Medicare program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 12, 2016 

Mr. TOM PRICE of Georgia (for himself, Mr. LOEBSACK, Mrs. MCMORRIS

RODGERS, Mr. WELCH, Mr. COLLINS of New York, Mr. CRAMER, Mr. 

FLORES, Mr. HARPER, Mr. LUETKEMEYER, Mr. ROE of Tennessee, Mr. 

THOMPSON of Pennsylvania, Mr. TIPTON, Ms. DUCKWORTH, Mr. DUNCAN of Tennessee, Mr. JOYCE, Mr. ZINKE, Mr. KELLY of Pennsylvania, 

Mr. BLUM, Mrs. ELLMERS of North Carolina, Mr. GOHMERT, Mr. LONG, 

Mr. HARRIS, Mr. RENACCI, Mr. TIBERI, Mr. PETERSON, Mr. MURPHY

of Pennsylvania, Mrs. NOEM, Mr. GIBBS, Mr. AUSTIN SCOTT of Georgia, 

Mr. GUTHRIE, Mr. DESJARLAIS, Ms. JENKINS of Kansas, Mr. DAVID

SCOTT of Georgia, Mrs. BLACK, Mrs. BLACKBURN, Mr. SMITH of Missouri, Mr. MULLIN, Mr. POMPEO, Mr. BYRNE, Mrs. WAGNER, and Mr. 

BOUSTANY) 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 improve access to durable medical equipment for Medicare 

beneficiaries under the Medicare program, 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, 

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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Patient Access to Du3 rable Medical Equipment Act of 2016’’ or the ‘‘PADME 

4 Act’’. 

5 SEC. 2. EXTENSION OF THE TRANSITION TO NEW PAYMENT 

6 RATES FOR DURABLE MEDICAL EQUIPMENT 

7 UNDER THE MEDICARE PROGRAM. 

8 The Secretary of Health and Human Services shall 

9 extend the transition period described in clause (i) of sec10 tion 414.210(g)(9) of title 42, Code of Federal Regula11 tions, from June 30, 2016, to September 30, 2017 (with 

12 the full implementation described in clause (ii) of such sec13 tion applying to items and services furnished with dates 

14 of service on or after October 1, 2017). 

15 SEC. 3. BID CEILING FOR COMPETITIVE ACQUISITION FOR 

16 DURABLE MEDICAL EQUIPMENT UNDER THE 

17 MEDICARE PROGRAM. 

18 Section 1847(b)(5) of the Social Security Act (42 

19 U.S.C. 1395w–3(b)(5)) is amended— 

20 (1) in subparagraph (A)— 

21 (A) by inserting ‘‘, subject to subpara22 graph (E),’’ after ‘‘subsection (a)(2)’’; and 

23 (B) by inserting ‘‘, subject to subpara24 graph (E),’’ after ‘‘Based on such bids’’; and 

25 (2) by adding at the end the following new sub26 paragraph: 

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1 ‘‘(E) BID CEILING FOR DURABLE MEDICAL

2 EQUIPMENT.— 

3 ‘‘(i) IN GENERAL.—The ceiling for a 

4 bid submitted for applicable covered items 

5 may not be less than the fee schedule 

6 amount that would otherwise be deter7 mined for such items under section 

8 1834(a), section 1834(h), or section 

9 1842(s)(1) on January 1, 2015, updated 

10 by the covered item update for such items 

11 under section 1834(a)(14)(L), section 

12 1834(h), or section 1842(s)(1), respec13 tively, as appropriate for the year with re14 spect to which the bid ceiling is established 

15 for such applicable covered item. 

16 ‘‘(ii) APPLICATION TO NEW COVERED

17 ITEMS.—The Secretary shall establish a 

18 process for purposes of applying clause (i) 

19 with respect to applicable covered items for 

20 which no fee schedule amount would other21 wise be paid under section 1834(a), section 

22 1834(h), or section 1842(s), as appro23 priate, on January 1, 2015. 

24 ‘‘(iii) APPLICABLE COVERED ITEMS

25 DEFINED.—For purposes of this subparamstockstill on DSK3G9T082PROD with BILLS

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1 graph, the term ‘applicable covered items’ 

2 means competitively priced items and serv3 ices described in subsection (a)(2) that are 

4 furnished with respect to rounds of com5 petition that begin on or after January 1, 

6 2017.’’. 

7 SEC. 4. REQUIREMENTS IN DETERMINING ADJUSTMENTS 

8 USING INFORMATION FROM COMPETITIVE 

9 BIDDING PROGRAMS. 

10 Section 1834(a)(1)(G) of the Social Security Act (42 

11 U.S.C. 1395m(a)(1)(G)) is amended by adding at the end 

12 the following new sentence: ‘‘In the case of items and serv13 ices furnished on or after January 1, 2019, in making any 

14 adjustments under clause (ii) or (iii) of subparagraph (F), 

15 the Secretary shall— 

16 ‘‘(i) solicit and take into account 

17 stakeholder input; and 

18 ‘‘(ii) take into account the highest 

19 amount bid by a winning supplier in a 

20 competitive acquisition area and a com21 parison of each of the following with re22 spect non-competitive acquisition areas and 

23 competitive acquisition areas: 

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1 ‘‘(I) The average travel distance 

2 and cost associated with furnishing 

3 items and services in the area. 

4 ‘‘(II) Any barriers to access for 

5 items and services in the area. 

6 ‘‘(III) The average delivery time 

7 in furnishing items and services in the 

8 area. 

9 ‘‘(IV) The average volume of 

10 items and services furnished by sup11 pliers in the area. 

12 ‘‘(V) The number of suppliers in 

13 the area.’’. 

14 SEC. 5. MONTHLY REPORT ON THE RESULTS OF THE MONI15 TORING OF ACCESS OF MEDICARE BENE16 FICIARIES TO DURABLE MEDICAL EQUIP17 MENT AND OF HEALTH OUTCOMES. 

18 Not later than the first of each month (beginning 

19 with May 1, 2016, and ending with September 1, 2017), 

20 the Secretary of Health and Human Services shall publish 

21 on the Internet website of the Centers for Medicare & 

22 Medicaid Services the results of the monitoring of access 

23 of Medicare beneficiaries to durable medical equipment 

24 and of health outcomes, as described on page 66228 in 

25 the final rule published by the Center for Medicare & Medmstockstill on DSK3G9T082PROD with BILLS

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1 icaid Services on November 6, 2014, and entitled ‘‘Medi2 care Program; End-Stage Renal Disease Prospective Pay3 ment System, Quality Incentive Program, and Durable 

4 Medical Equipment, Prosthetics, Orthotics, and Supplies’’ 

5 (79 Fed. Reg. 66120–66265). 

6 SEC. 6. REQUIRING REDUCTION IN FEDERAL EXPENDI7 TURES TO FULLY OFFSET INCREASED EX8 PENDITURES FROM THIS ACT. 

9 It is the sense of Congress that this Act should not 

10 be enacted unless the increase in Federal expenditures 

11 under this Act is fully offset through a decrease in other 

12 Federal expenditures. 

Æ 

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