I 
115TH CONGRESS 
1ST SESSION H. R. 4679 
To amend title XVIII of the Social Security Act to provide for improvements 
to coverage and payment under the Medicare program for new drugs, 
devices, and technology. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 18, 2017 
Mr. REED (for himself and Mr. REICHERT) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently 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 provide 
for improvements to coverage and payment under the 
Medicare program for new drugs, devices, and tech-
nology. 
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 ‘‘Ensuring Equal Access 
to Treatments Act of 2017’’. 
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SEC. 2. COVERAGE AND PAYMENT FOR NEW DRUGS, DE-
VICES, AND TECHNOLOGY UNDER THE MEDI-
CARE PROGRAM. 
(a) IMPROVEMENTS TO NTAP PAYMENT ADJUST-
MENT UNDER THE INPATIENT PROSPECTIVE PAYMENT 
SYSTEM.— 
(1) PAYMENT
FOR
COSTS
OF
NEW
TECH-
NOLOGIES.—With respect to hospital discharges oc-
curring on or after October 1, 2018, for which pay-
ment is made under section 1886(d) of the Social 
Security Act (42 U.S.C. 1395ww(d)), in calculating 
the amount of the additional payment for a new 
medical service or technology under paragraph 
(5)(K) of such section with respect to such a dis-
charge, the Secretary of Health and Human Services 
shall apply section 412.88 of title 42, Code of Fed-
eral Regulations— 
(A) as if the reference to ‘‘50 percent’’ 
each place it appears in such section were a ref-
erence to ‘‘75 percent’’; and 
(B) as if paragraph (b) of such section did 
not include ‘‘Unless a discharge case qualifies 
for outlier payment under § 412.84.’’. 
(2) REVISION TO THE COST THRESHOLD.—Sec-
tion 1886(d)(5)(K) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(K)) is amended— 
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(A) in clause (ii)— 
(i) in subclause (I), by striking ‘‘75 
percent’’ each place it appears and insert-
ing ‘‘50 percent’’; and 
(ii) in subclause (II), by striking ‘‘not 
less than two years and not more than 
three years’’ and inserting ‘‘five years’’; 
and 
(B) in clause (iii), by striking ‘‘Inter-
national Classification of Diseases, 9th Revi-
sion, Clinical Modification (‘‘ICD–9–CM’’)’’ and 
inserting ‘‘International Classification of Dis-
eases, 10th Revision, Clinical Modification 
(‘‘ICD–10–CM’’)’’. 
(3) REVISION TO THE COMMENCEMENT OF THE 
PERIOD FOR COLLECTION OF COST DATA FOR NEW 
TECHNOLOGIES.—Section 1886(d)(5)(K)(ii)(II) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(5)(K)(ii)(II)) is amended by inserting 
‘‘the later of the date that is the date of the clear-
ance or approval by the Commissioner of Food and 
Drugs of the service or technology or’’ after ‘‘begin-
ning on’’. 
(4) PERMITTING
APPEALS
OF
NTAP
DETER-
MINATIONS.— 
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(A) IN GENERAL.—Section 1886(d)(5)(K) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(5)(K)) is amended by adding at the 
end the following new clause: 
‘‘(x)(I) An individual or entity that submits an appli-
cation for additional payment under this subparagraph for 
a new technology shall be entitled to administrative review 
of an adverse determination by the Secretary with respect 
to such application. 
‘‘(II) The Secretary shall establish a process for ad-
ministrative review for purposes of subclause (I). Under 
such process, administrative review shall be conducted by 
the Departmental Appeals Board of the Department of 
Health and Human Services. Under such process, the De-
partmental Appeals Board shall complete administrative 
review within 90 days of the date of receipt of the request 
for such review.’’. 
(B) CONFORMING
AMENDMENT.—Section 
1886(d)(7)(B) 
of 
such 
Act 
(42 
U.S.C. 
1395ww(d)(7)(B)) is amended by inserting ‘‘but 
not including a denial by the Secretary of an 
application for additional payment under para-
graph (5)(K)’’ after ‘‘paragraph (4)(D)’’. 
(5) REQUIRING
NEW
DRG
CODES
FOR
NEW 
TECHNOLOGIES COMING OFF OF NEW TECHNOLOGY 
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