SEC. 2. PROVIDING FOR COVERAGE OF ALS-RELATED SERV-
ICES UNDER THE MEDICARE PROGRAM FOR 
INDIVIDUALS 
DIAGNOSED 
WITH 
AMYOTROPHIC LATERAL SCLEROSIS. 
(a) IN GENERAL.—Subtitle E of title XVIII of the 
Social Security Act (42 U.S.C. 1395 et. seq.) is amended 
by inserting after section 1881A the following new section: 
‘‘SEC. 1881B. MEDICARE COVERAGE OF ALS-RELATED SERV-
ICES FOR INDIVIDUALS DIAGNOSED WITH 
AMYOTROPHIC LATERAL SCLEROSIS. 
‘‘(a) IN GENERAL.—In the case of a covered ALS 
individual, the Secretary shall establish a supplemental fa-
cility-based payment system described in subsection (d) 
for ALS-related services provided to such an individual. 
‘‘(b) COVERED ALS INDIVIDUAL.—For purposes of 
this section, the term ‘covered ALS individual’ means an 
individual 
who 
is 
medically 
determined 
to 
have 
amyotrophic lateral sclerosis (as described in section 
226(h)). 
‘‘(c) ALS-RELATED SERVICES.—For purposes of this 
section, the term ‘ALS-related services’ means items and 
services that are ordinarily furnished to a covered ALS 
individual in an outpatient setting by a qualified provider 
(or by others under arrangements with them made by the 
qualified provider) consistent with a multidisciplinary ap-
proach (as determined by the Secretary) for the care and 
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treatment of such an individual with respect to the pro-
gression of amyotrophic lateral sclerosis. 
‘‘(d) PAYMENT SYSTEM.— 
‘‘(1) AUTHORITY.—The Secretary shall estab-
lish a facility-based payment system under which a 
single payment determined in accordance with the 
succeeding paragraphs is made to a qualified pro-
vider for ALS-related services furnished to a covered 
ALS individual during a visit beginning on and after 
January 1, 2024. 
‘‘(2) BASE PAYMENT AMOUNT.— 
‘‘(A) 2024.—For coverage year 2024, the 
Secretary shall establish a single payment 
amount for ALS-related services equal to $800 
for such services furnished for each visit during 
such year. 
‘‘(B) 2025.— 
‘‘(i) IN GENERAL.—For coverage year 
2025, the Secretary shall establish a single 
payment amount for ALS-related services 
furnished for each visit during such year 
that is the greater of— 
‘‘(I) taking into account the pay-
ment amount recommended by the 
Comptroller General in the report de-
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scribed in clause (ii), the amount 
specified by the Secretary; or 
‘‘(II) the amount specified in 
subparagraph (A). 
‘‘(ii) REPORT BY THE COMPTROLLER 
GENERAL.—Not later than January 1, 
2024, the Comptroller General shall, in 
consultation with qualified providers sub-
mit to the Secretary of Health and Human 
Services a report that recommends a single 
payment amount for ALS-related services 
that takes into account the average 
amount of payment for each item or serv-
ice included in ALS-related services that 
the Comptroller General estimates would 
have been payable— 
‘‘(I) under this title for such a 
service based on per patient utilization 
data from whichever single coverage 
year from 2020 through 2022 has the 
highest per patient utilization of ALS- 
related services, even if such service is 
not payable for a particular ALS indi-
vidual because of the application of 
section 1862(a)(1)(A) with respect to 
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an item or service provided to such in-
dividual; 
‘‘(II) in the case an estimate is 
unable to be determined pursuant to 
subclause (I), by health insurance 
issuers and group health plans (as 
such terms are defined in section 
2791 of the Public Health Service 
Act) and MA plans under part C for 
such a service, based on such data 
from whichever single coverage year 
from 2020 through 2022 has the 
highest per patient utilization of ALS- 
related services; and 
‘‘(III) in the case an estimate is 
unable to be determined pursuant to 
subclause (II), based on the rec-
ommendation of the Specialty Society 
Relative Value Scale Update Com-
mittee of the American Medical Asso-
ciation or the estimate of the Comp-
troller General for such a service. 
‘‘(C) 2026 AND SUBSEQUENT YEARS.—For 
each coverage year beginning with coverage 
year 2026, the Secretary shall annually increase 
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the payment amount for each visit determined 
under this paragraph by an ALS services mar-
ket basket percentage increase (as determined 
by the Secretary) that reflects changes over 
time in the prices of an appropriate mix of 
goods and services that are ALS-related serv-
ices. 
‘‘(3) PAYMENT
ADJUSTMENTS.—The payment 
system under this subsection— 
‘‘(A) shall include a payment adjustment 
based on case mix that may take into account 
comorbidities, length of time from diagnosis, 
age, race, ethnicity, and other appropriate fac-
tors; 
‘‘(B) shall include a payment adjustment 
for high-cost outliers due to unusual variations 
in the type or amount of medically necessary 
care; 
‘‘(C) shall include a payment adjustment 
that reflects the extent to which costs incurred 
by low-volume facilities (as defined by the Sec-
retary) in furnishing ALS-related services ex-
ceed the costs incurred by other facilities in fur-
nishing such services, and such payment adjust-
ment may not be less than 10 percent; 
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‘‘(D) shall include a payment adjustment 
for a medical service or technology which is fur-
nished as a part of ALS-related services for 
which, as determined by the Secretary— 
‘‘(i) payment for the service or tech-
nology as part of ALS-related services 
under this section was not being made in 
the preceding coverage year; and 
‘‘(ii) the cost of the service or tech-
nology is not insignificant in relation the 
payment amount (as determined under this 
subsection) payable for ALS-related serv-
ices; and 
‘‘(E) may include such other payment ad-
justments as the Secretary deems appropriate, 
including a payment adjustment for— 
‘‘(i) a geographic index, such as the 
index referred to in section 1886(d)(3)(E); 
‘‘(ii) the status of the facility as pro-
vider-based or free-standing (as such terms 
are defined in section 413.65(a)(2), title 
42, Code of Federal Regulations); and 
‘‘(iii) qualified providers located in 
rural 
areas 
(as 
defined 
in 
section 
1886(d)(2)(D)). 
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‘‘(4) MECHANISM
FOR
PAYMENTS.—For pur-
poses of making payments for ALS-related services, 
the Secretary shall establish a mechanism under the 
payment system under this subsection which makes 
payment when a qualified provider submits a claim 
for reimbursement which includes, with respect to a 
covered ALS individual, an alphanumeric code 
issued under the International Classification of Dis-
eases, 10th Revision, Clinical Modification (‘ICD– 
10–CM’) and its subsequent revisions that is for the 
treatment of a diagnosis of amyotrophic lateral scle-
rosis. 
‘‘(5) NO COST SHARING.—Payment under this 
subsection shall be made only on an assignment-re-
lated basis without any cost sharing. 
‘‘(6) QUALIFIED PROVIDER DEFINED.—In this 
section, the term ‘qualified provider’ means a pro-
vider of services which meets requirements as the 
Secretary prescribes by regulation. 
‘‘(e) CLARIFICATION.—Payment under subsection (d) 
shall be in addition to, and shall not supplant, any pay-
ment that would be otherwise made to a provider of serv-
ices, physician, practitioner, supplier, or laboratory under 
any other provision of this title for an item or service fur-
nished to a covered ALS individual. 
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‘‘(f) IMPLEMENTATION.— 
‘‘(1) IN GENERAL.—Except as provided under 
paragraph (2), the Secretary may implement the 
provisions of this section by program instruction or 
otherwise. 
‘‘(2) RULEMAKING.—The Secretary shall imple-
ment subsections (c) and (d)(6) through notice and 
comment rulemaking. 
‘‘(g) FUNDING.—For purposes of carrying out this 
section, subject to subsection (e), payment under this sec-
tion shall be made from the Federal Supplementary Med-
ical Insurance Trust Fund under section 1841 or from 
the Federal Hospital Insurance Trust Fund under section 
1817.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1833(t) of the Social Security Act 
(42 U.S.C. 1395(t) is amended by adding at the end 
the following new paragraph: 
‘‘(23) ENSURING
SUPPLEMENTAL
PAYMENTS 
FOR
ALS-RELATED
SERVICES.—Any covered OPD 
service furnished to a covered ALS individual (as de-
fined in section 1881B(b)) that is otherwise payable 
to a qualified provider (as defined in section 
1881B(d)(6)) pursuant to paragraph (4) shall be 
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payable under such paragraph notwithstanding any 
payment made under section 1881B(d).’’. 
(2) Section 1861(w)(1) of the Social Security 
Act (42 U.S.C. 1395x(w)(1)) is amended by insert-
ing ‘‘qualified provider (as defined in section 
1881B(d)(6)(A)) with respect to ALS-related serv-
ices (as defined in section 1881B(c)),’’ before ‘‘or 
hospice program’’. 
SEC. 3. EFFECTIVE DATE. 
The amendments made by this Act shall take effect 
on the date of the enactment of this Act. 
Æ 
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