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 Com-
mittee 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Beneficiary Res-
piratory Equipment Access and Transparency to Home 
Ventilator Care Act of 2016’’ or the ‘‘BREATH Act of 
2016’’. 
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SEC. 2. PROMOTING EVIDENCE-BASED CARE FOR CERTAIN 
VENTILATORS AND OTHER ITEMS OF DURA-
BLE MEDICAL EQUIPMENT. 
Section 1834(a) of the Social Security Act (42 U.S.C. 
1395(m)) is amended by adding at the end the following 
new subsection: 
‘‘(t) APPROPRIATE USE CRITERIA
FOR CERTAIN 
VENTILATORS.—Not later than January 1, 2017, and in 
consultation with medical experts, the Secretary shall es-
tablish policies and standards for determining the appro-
priate use of ventilators as described in subsection 
(a)(3)(A).’’. 
SEC. 3. REIMBURSEMENT FOR HOME MECHANICAL VEN-
TILATORS. 
(a) IN GENERAL.—Section 1834(a)(3) of the Social 
Security Act (42 U.S.C. 1395m(a)(3)) is amended— 
(1) in subparagraph (B)— 
(A) in clause (iii), by striking ‘‘and’’ at the 
end; 
(B) in clause (iv)— 
(i) by inserting ‘‘, except as provided 
in clause (v),’’ after ‘‘subsequent year’’; 
and 
(ii) by striking the period at the end 
and inserting ‘‘; and’’; and 
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(C) by adding at the end the following new 
clause: 
‘‘(v) in 2017 and each subsequent 
year, in the case of a ventilator described 
in subparagraph (A), the payment rate de-
termined for the ventilator under subpara-
graph (D) for that year.’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) PAYMENT
RATES
FOR
VENTILA-
TORS.—For purposes of subparagraph (B)(v), 
payment for a ventilator described in subpara-
graph (A) shall be made as follows: 
‘‘(i) 
2017 
PAYMENT
RATE.—For 
2017, at a rate equal to 120 percent of the 
rate determined under subparagraph (B) 
for 2016, increased by the covered item 
update for the year. 
‘‘(ii) 
2018 
PAYMENT
RATE.—For 
2018, at the rate determined under this 
subparagraph for 2017— 
‘‘(I) increased by the covered 
item update for the year; 
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‘‘(II) increased or decreased, ex-
pressed as a percentage, by the dif-
ference between— 
‘‘(aa) the absolute percent-
age difference in the number of 
beneficiaries for whom the pro-
gram made payment for the rent-
al of such item or device during 
2017 and the number of bene-
ficiaries for whom the program 
made payment for the rental of 
the item or device during 2015; 
and 
‘‘(bb) 20 percent; and 
‘‘(III) increased or decreased by 
the percentage change in the total 
number of Medicare beneficiaries in 
2015 as compared to 2017. 
‘‘(iii) 2019 AND SUBSEQUENT YEARS 
PAYMENT
RATE.—For 2019 and subse-
quent years, at the rate determined under 
this subparagraph for the previous year in-
creased by the covered item update for the 
year.’’. 
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(b) APPLICATION.—The Secretary shall implement 
the provisions of, and amendments made by, this section 
in a budget neutral manner. 
Æ 
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