[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5210 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 5210

      To improve access to durable medical equipment for Medicare 
   beneficiaries under the Medicare program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 12, 2016

  Mr. Tom Price of Georgia (for himself, Mr. Loebsack, Mrs. McMorris 
 Rodgers, Mr. Welch, Mr. Collins of New York, Mr. Cramer, Mr. Flores, 
  Mr. Harper, Mr. Luetkemeyer, Mr. Roe of Tennessee, Mr. Thompson of 
 Pennsylvania, Mr. Tipton, Ms. Duckworth, Mr. Duncan of Tennessee, Mr. 
Joyce, Mr. Zinke, Mr. Kelly of Pennsylvania, Mr. Blum, Mrs. Ellmers of 
  North Carolina, Mr. Gohmert, Mr. Long, Mr. Harris, Mr. Renacci, Mr. 
Tiberi, Mr. Peterson, Mr. Murphy of Pennsylvania, Mrs. Noem, Mr. Gibbs, 
 Mr. Austin Scott of Georgia, Mr. Guthrie, Mr. DesJarlais, Ms. Jenkins 
of Kansas, Mr. David Scott of Georgia, Mrs. Black, Mrs. Blackburn, Mr. 
Smith of Missouri, Mr. Mullin, Mr. Pompeo, Mr. Byrne, Mrs. Wagner, and 
Mr. Boustany) introduced the following bill; which was 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

_______________________________________________________________________

                                 A BILL


 
      To improve access to durable medical equipment for Medicare 
   beneficiaries under the Medicare program, 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 ``Patient Access to Durable Medical 
Equipment Act of 2016'' or the ``PADME Act''.

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 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).

SEC. 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.''.

SEC. 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.''.

SEC. 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).

SEC. 6. REQUIRING REDUCTION IN FEDERAL EXPENDITURES TO FULLY OFFSET 
              INCREASED EXPENDITURES FROM THIS ACT.

    It is the sense of Congress that this Act should not be enacted 
unless the increase in Federal expenditures under this Act is fully 
offset through a decrease in other Federal expenditures.
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