Medicare Ventricular Assist Device Access Act of 2015

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. Short title This Act may be cited as the Medicare Ventricular Assist Device Access Act of 2015 2. Findings; purpose (a) Findings Congress finds the following: (1) Ventricular assistance devices are mechanical blood pumps that surgeons attach to a damaged or weakened native heart to assist in pumping blood. (2) Under its coverage policy as of the date of the enactment of this Act, the Medicare program covers ventricular assist devices for Medicare beneficiaries that meet certain criteria after open-heart surgery, that are approved and listed as candidates for heart transplant by a Medicare-approved heart transplant center, and for those who are not eligible for a heart transplant. (3) The Medicare program does not currently cover Medicare beneficiaries for ventricular assist devices who are— (A) undergoing an evaluation to determine their candidacy for heart transplantation; or (B) potential heart transplant candidates, but who are currently not eligible for heart transplantation because of a contraindication that may be favorably modified by the use of a ventricular assist device. (4) Approximately 40 percent of patients who receive a ventricular assist device are not eligible for a heart transplant initially, but may become eligible as the ventricular support improves their overall health. (b) Purpose The purpose of this Act is to ensure Medicare beneficiaries with heart failure have appropriate access to ventricular assist devices. 3. Revision of Medicare ventricular assist device national coverage policy (a) In general Notwithstanding section 1862(a)(1)(A) of the Social Security Act ( 42 U.S.C. 1395y(a)(1)(A) Secretary 42 U.S.C. 1395ff(f)(1)(B) (1) individuals who are undergoing an evaluation to determine candidacy for heart transplantation; and (2) individuals who would be potential heart transplant candidates, but are not so eligible because of a contraindication that may be favorably modified by the use of a ventricular assist device. (b) Construction Nothing in this section shall be construed— (1) to limit coverage of ventricular assist devices for Medicare beneficiaries who meet the Medicare criteria for coverage of ventricular assist devices as of the date of enactment of this Act; or (2) as preventing the Secretary from expanding its coverage decision beyond the coverage required under this section. (c) Revision of national coverage decision; effective date (1) Revision of national coverage decision The Secretary shall use the processes described in section 1862(l) of the Social Security Act ( 42 U.S.C. 1395y(l) (2) Effective date The revised coverage decision described in paragraph (1) shall apply to ventricular assist devices furnished on or after the date that is 30 days after the date of the enactment of this Act, regardless of the date on which the Secretary completes the process required under such paragraph.

Summary: Medicare Ventricular Assist Device Access Act of 2015 Directs the Department of Health and Human Services (HHS) to revise the Medicare national coverage determination relating to coverage of ventricular assist devices to extend the coverage of such devices under title XVIII (Medicare) of the Social Security Act for individuals approved for heart transplantation to apply also to: (1) individuals undergoing an evaluation to determine candidacy for heart transplantation; and (2) individuals who would be heart transplant candidates, but are not so eligible because of a contraindication that may be favorably modified by the use of a ventricular assist device. Directs HHS to use specified processes to revise its national coverage determination relating to ventricular assist devices to incorporate the requirements of this Act.