Patient Access to Durable Medical Equipment Act of 2016

Bill: 114-s-2736
Sponsor: full_name: Sen. Thune, John [R-SD]
Introduced: 2016-03-17
Policy area: Health
Subjects: Government information and archives

Health care coverage and access

Health technology, devices, supplies

Medicaid

Medicare

Public contracts and procurement
Latest action: action_date: 2016-06-29
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2016-03-17
action_desc: Introduced in Senate
text: <p><strong>Patient Access to Durable Medical Equipment Act of 2016</strong></p> <p><strong></strong>This bill amends title XVIII (Medicare) of the Social Security Act to establish a bid ceiling for durable medical equipment (such as wheelchairs) under Medicare's competitive acquisition program, through which rates are set according to a bidding process rather than by an established fee schedule. Specifically, the bid ceiling for such an item shall not be less than the fee schedule amount that would otherwise be determined.</p> <p>Under current law, the Centers for Medicare &amp; Medicaid Services (CMS) must use payment information from competitive acquisition programs to make payment adjustments for areas outside of such programs. 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:</p> <ul> <li>average travel distance and cost associated with furnishing items and services, </li> <li>barriers to access, </li> <li>average delivery time, </li> <li>average volume of items and services furnished by suppliers, and </li> <li>number of suppliers.</li></ul> <p>In addition, CMS shall delay by 15 months the full implementation of new Medicare payment rates for durable medical equipment.</p> <p>On a monthly basis, CMS must publish on its website the results of the monitoring of health outcomes and Medicare beneficiaries' access&nbsp;to durable medical equipment.</p> <p>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.</p>

action_date: 2016-06-21
action_desc: Passed Senate amended
text: <p><strong>Patient Access to Durable Medical Equipment Act of 2016</strong></p> <p><strong></strong>(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).</p> <p>(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.</p> <p>(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:</p> <ul> <li>average travel distance and cost associated with furnishing items and services, </li> <li>barriers to access, </li> <li>average delivery time, </li> <li>average volume of items and services furnished by suppliers, and </li> <li>number of suppliers.</li></ul> <p>(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.</p> <p>(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.</p>

tv_txt: II 114th CONGRESS 2d Session S. 2736 IN THE SENATE OF THE UNITED STATES March 17, 2016 Mr. Thune (for himself, Ms. Heitkamp , Mr. Roberts , Mr. Crapo , Mr. Rounds , Mrs. Capito , Mr. Grassley , Mr. Manchin , Mr. Daines , Mr. Barrasso , Mr. Cochran , Ms. Hirono , Mr. Bennet , Mrs. Ernst , Mr. King , and Mr. Tester ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To improve access to durable medical equipment for Medicare beneficiaries under the Medicare program, and for other purposes.

1. Short title This Act may be cited as the Patient Access to Durable Medical Equipment Act of 2016 . 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 September 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 October 1, 2017). 3. 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) 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 for such items under section 1834(a), section 1834(h), or section 1842(s)(1) on January 1, 2015, updated by the covered item update for such items under section 1834(a)(14)(L), section 1834(h), or section 1842(s)(1), respectively, as appropriate for the year with respect to which the bid ceiling is established for such applicable covered item. (ii) Application to new covered items The Secretary shall establish a process for purposes of applying clause (i) with respect to applicable covered items for which no fee schedule amount would otherwise be paid under section 1834(a), section 1834(h), or section 1842(s), as appropriate, on January 1, 2015. (iii) 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. . 4. Requirements in determining adjustments using information from competitive bidding programs 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), 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 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. . 5. Monthly report on the results of the monitoring of access of Medicare beneficiaries to durable medical equipment and of health outcomes Not later than the first of each month (beginning with May 1, 2016, and ending with September 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). 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 .

tv_txt: 114th CONGRESS 2d Session S. 2736 IN THE SENATE OF THE UNITED STATES AN ACT To improve access to durable medical equipment for Medicare beneficiaries under the Medicare program, and for other purposes.

1. Short title This Act may be cited as the Patient Access to Durable Medical Equipment Act of 2016 . 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). 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. . 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 . 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). 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. Secretary

tv_txt: IC 114th CONGRESS 2d Session S. 2736 IN THE HOUSE OF REPRESENTATIVES June 21, 2016 Referred to the Committee 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 AN ACT To improve access to durable medical equipment for Medicare beneficiaries under the Medicare program, and for other purposes.

1. Short title This Act may be cited as the Patient Access to Durable Medical Equipment Act of 2016 . 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). 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. . 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 . 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). 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. Julie E. Adams, Secretary