Title: BREATH Act of 2017
Policy area: Health

Summary:
Beneficiary Respiratory Equipment Access and Transparency to Home Ventilator Care Act of 2017 or the BREATH Act of 2017
This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish by January 1, 2018, policies and standards for determining the appropriate use of certain ventilators under the Medicare program. The CMS may delay such establishment until January 1, 2020, for certain ventilators furnished to individuals with specified medical diagnoses.
Subject to budget neutrality requirements, the bill increases the Medicare payment rate for such ventilators for 2018 and subsequent years.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2175 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  1st Session
                                S. 2175

 To amend title XVIII of the Social Security Act to preserve Medicare 
       beneficiary access to ventilators, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 30, 2017

Mr. Cassidy (for himself, Mr. Manchin, and Mr. Grassley) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Beneficiary Respiratory Equipment 
Access and Transparency to Home Ventilator Care Act of 2017'' or the 
``BREATH Act of 2017''.

SEC. 2. PROMOTING EVIDENCE-BASED CARE FOR CERTAIN VENTILATORS AND OTHER 
              ITEMS OF DURABLE MEDICAL EQUIPMENT.

    Section 1834 of the Social Security Act (42 U.S.C. 1395m) is 
amended by adding at the end the following new subsection:
    ``(v) Appropriate Use Criteria for Certain Ventilators.--
            ``(1) In general.--Not later than January 1, 2018, subject 
        to paragraph (2), and in consultation with medical experts and 
        applicable stakeholders, the Secretary shall establish and 
        implement policies and standards for determining the 
        appropriate use of ventilators as described in subsection 
        (a)(3)(A).
            ``(2) Delay in implementation of appropriate use criteria 
        for use by certain individuals.--The Secretary may, as the 
        Secretary determines appropriate, delay until such date as the 
        Secretary determines appropriate but not later than January 1, 
        2020, the establishment and implementation of appropriate use 
        criteria as described in paragraph (1) (which may be the same 
        appropriate use criteria established and implemented under such 
        paragraph) for ventilators furnished to individuals diagnosed 
        with neuromuscular or other thoracic restrictive diseases or 
        cystic fibrosis.''.

SEC. 3. REIMBURSEMENT FOR HOME MECHANICAL VENTILATORS.

    (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
                    (C) by adding at the end the following new clause:
                            ``(v) for an item or device furnished on or 
                        after January 1, 2018, in the case of a 
                        ventilator described in subparagraph (A), the 
                        payment rate determined for the ventilator 
                        under subparagraph (D) for the year.''; and
            (2) by adding at the end the following new subparagraphs:
                    ``(D) 2018 and subsequent years payment rates for 
                ventilators.--For purposes of subparagraph (B)(v), the 
                payment rate determined under this subparagraph for a 
                ventilator described in subparagraph (A) is the 
                following:
                            ``(i) 2018.--For 2018, the payment amount 
                        specified in subparagraph (B) for an item or 
                        device furnished on or after July 1, 2017, and 
                        before January 1, 2018, increased by the 
                        covered item update for 2018.
                            ``(ii) 2019.--For 2019, the rate determined 
                        under clause (i) for 2018--
                                    ``(I) increased by the covered item 
                                update for 2019; and
                                    ``(II) if applicable, increased by 
                                the budget neutrality adjustment under 
                                subparagraph (E).
                            ``(iii) 2020 and subsequent years.--For 
                        2020 and subsequent years, the rate determined 
                        under this subparagraph for an item or device 
                        furnished on December 31 of the previous year, 
                        increased by the covered item update for the 
                        year.
                    ``(E) Budget neutrality adjustment of payment rates 
                for ventilators for 2019.--
                            ``(i) In general.--Subject to the 
                        succeeding clauses of this subparagraph, the 
                        Secretary shall implement the provisions of 
                        subparagraphs (B)(v) and (D) in a budget 
                        neutral manner and any budget neutrality 
                        adjustment under this subparagraph shall be 
                        limited to payments for a ventilator described 
                        in subparagraph (A) furnished during 2019.
                            ``(ii) Computation of aggregate budget 
                        neutrality adjustment.--The aggregate budget 
                        neutrality adjustment under this subparagraph 
                        shall be an amount equal to the difference (if 
                        any) between--
                                    ``(I) aggregate payments under this 
                                part for ventilators described in 
                                subparagraph (A) furnished during 2017, 
                                as adjusted under subclause (I) of 
                                clause (iii); and
                                    ``(II) aggregate payments under 
                                this part for such ventilators 
                                furnished during 2018, as adjusted 
                                under subclause (II) of such clause.
                            ``(iii) Adjustments.--For purposes of 
                        clause (ii)--
                                    ``(I) payments described in 
                                subclause (I) of such clause shall be 
                                increased by the covered item update 
                                for 2018; and
                                    ``(II) payments described in 
                                subclause (II) of such clause shall be 
                                increased or decreased by the 
                                percentage change in the total number 
                                of individuals enrolled under this part 
                                (other than Medicare Advantage 
                                enrollees) from 2017 to 2018.''.
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