Patient Access to Durable Medical Equipment Act of 2016

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Patient Access to Durable Medical 
Equipment Act of 2016''.

SEC. 2. EXTENSION OF THE TRANSITION TO NEW PAYMENT RATES FOR DURABLE 
              MEDICAL EQUIPMENT UNDER THE MEDICARE PROGRAM.

    The Secretary of Health and Human Services shall extend the 
transition period described in clause (i) of section 414.210(g)(9) of 
title 42, Code of Federal Regulations, from June 30, 2016, to June 30, 
2017 (with the full implementation described in clause (ii) of such 
section applying to items and services furnished with dates of service 
on or after July 1, 2017).

SEC. 3. FLOOR ON BID CEILING FOR COMPETITIVE ACQUISITION FOR DURABLE 
              MEDICAL EQUIPMENT UNDER THE MEDICARE PROGRAM.

    Section 1847(b)(5) of the Social Security Act (42 U.S.C. 1395w-
3(b)(5)) is amended--
            (1) in subparagraph (A)--
                    (A) by inserting ``, subject to subparagraph (E),'' 
                after ``subsection (a)(2)''; and
                    (B) by inserting ``, subject to subparagraph (E),'' 
                after ``Based on such bids''; and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Floor on bid ceiling for durable medical 
                equipment.--
                            ``(i) In general.--The ceiling for a bid 
                        submitted for applicable covered items may not 
                        be less than the fee schedule amount that would 
                        otherwise be determined under section 1834(a), 
                        section 1834(h), or section 1842(s) for such 
                        items furnished on July 1, 2016 (determined as 
                        if section 2 of the Patient Access to Durable 
                        Medical Equipment Act of 2016 had not been 
                        enacted).
                            ``(ii) Applicable covered items defined.--
                        For purposes of this subparagraph, the term 
                        `applicable covered items' means competitively 
                        priced items and services described in 
                        subsection (a)(2) that are furnished with 
                        respect to rounds of competition that begin on 
                        or after January 1, 2017.''.

SEC. 4. REQUIREMENTS IN DETERMINING ADJUSTMENTS USING INFORMATION FROM 
              COMPETITIVE BIDDING PROGRAMS.

    (a) In General.--Section 1834(a)(1)(G) of the Social Security Act 
(42 U.S.C. 1395m(a)(1)(G)) is amended by adding at the end the 
following new sentence: ``In the case of items and services furnished 
on or after January 1, 2019, in making any adjustments under clause 
(ii) or (iii) of subparagraph (F), under subsection (h)(1)(H)(ii), or 
under section 1842(s)(3)(B), the Secretary shall--
                            ``(i) solicit and take into account 
                        stakeholder input; and
                            ``(ii) take into account the highest amount 
                        bid by a winning supplier in a competitive 
                        acquisition area and a comparison of each of 
                        the following with respect to non-competitive 
                        acquisition areas and competitive acquisition 
                        areas:
                                    ``(I) The average travel distance 
                                and cost associated with furnishing 
                                items and services in the area.
                                    ``(II) Any barriers to access for 
                                items and services in the area.
                                    ``(III) The average delivery time 
                                in furnishing items and services in the 
                                area.
                                    ``(IV) The average volume of items 
                                and services furnished by suppliers in 
                                the area.
                                    ``(V) The number of suppliers in 
                                the area.''.
    (b) Conforming Amendments.--(1) Section 1834(h)(1)(H)(ii) of the 
Social Security Act (42 U.S.C. 1395m(h)(1)(H)(ii)) is amended by 
striking ``the Secretary'' and inserting ``subject to subsection 
(a)(1)(G), the Secretary''.
    (2) Section 1842(s)(3)(B) of the Social Security Act (42 U.S.C. 
1395m(s)(3)(B)) is amended by striking ``the Secretary'' and inserting 
``subject to section 1834(a)(1)(G), the Secretary''.

SEC. 5. REPORTS ON THE RESULTS OF THE MONITORING OF ACCESS OF MEDICARE 
              BENEFICIARIES TO DURABLE MEDICAL EQUIPMENT AND OF HEALTH 
              OUTCOMES.

    Not later than October 1, 2016, January 1, 2017, April 1, 2017, and 
July 1, 2017, the Secretary of Health and Human Services shall publish 
on the Internet website of the Centers for Medicare & Medicaid Services 
the results of the monitoring of access of Medicare beneficiaries to 
durable medical equipment and of health outcomes, as described on page 
66228 in the final rule published by the Center for Medicare & Medicaid 
Services on November 6, 2014, and entitled ``Medicare Program; End-
Stage Renal Disease Prospective Payment System, Quality Incentive 
Program, and Durable Medical Equipment, Prosthetics, Orthotics, and 
Supplies'' (79 Fed. Reg. 66120-66265).

SEC. 6. REVISION OF EFFECTIVE DATE OF PROVISION LIMITING FEDERAL 
              MEDICAID REIMBURSEMENT TO STATES FOR DURABLE MEDICAL 
              EQUIPMENT (DME) TO MEDICARE PAYMENT RATES.

    (a) In General.--Section 1903(i)(27) of the Social Security Act (42 
U.S.C. 1396b(i)(27)) is amended by striking ``January 1, 2019'' and 
inserting ``October 1, 2018''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the enactment of section 503 of division 
O of Public Law 114-113.

            Passed the Senate June 21, 2016.

            Attest:

                                                JULIE E. ADAMS,

                                                             Secretary.

Summary: Patient Access to Durable Medical Equipment Act of 2016 (Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act to delay by one year&nbsp;the full implementation of new Medicare payment rates for durable medical equipment (such as wheelchairs). (Sec. 3)&nbsp;In addition, the bill&nbsp;specifies that the bid ceiling for durable medical equipment items&nbsp;under Medicare's competitive acquisition program (through which rates are set according to a bidding process rather than by an established fee schedule) shall not be less than the fee schedule amount that would otherwise be determined for those items. (Sec. 4) Under current law, the Centers for Medicare &amp; Medicaid Services (CMS) must use payment information from competitive acquisition programs to make payment adjustments for durable medical equipment items furnished in areas outside of such programs. Current law also allows, but does not require,&nbsp;CMS to make such adjustments with respect to certain orthotics (such as splints and braces) and parenteral and enteral nutrients, equipment, and supplies (such as feeding tubes).&nbsp;The bill requires CMS, in making&nbsp;these adjustments, to account for&nbsp;stakeholder input. In addition, CMS must account for a comparison of competitive acquisition areas and other areas with respect to the following factors:  average travel distance and cost associated with furnishing items and services,  barriers to access,  average delivery time,  average volume of items and services furnished by suppliers, and  number of suppliers. (Sec. 5) In four quarterly reports, CMS must publish on its website the results of the monitoring of health outcomes and Medicare beneficiaries' access&nbsp;to durable medical equipment. (Sec. 6) The bill accelerates the applicability, from January 1, 2019, to October 1, 2018,&nbsp;of provisions of current law&nbsp;that limit&nbsp;federal&nbsp;Medicaid reimbursement to states for durable medical equipment to Medicare payment rates.