[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 1253 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                S. 1253

To amend title XVIII of the Social Security Act to provide coverage of 
certain disposable medical technologies under the Medicare program, and 
                          for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 7, 2015

 Mr. Burr (for himself and Mr. Bennet) 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 provide coverage of 
certain disposable medical technologies 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 Disposable Medical 
Technology Act of 2015''.

SEC. 2. COVERAGE OF CERTAIN DISPOSABLE MEDICAL TECHNOLOGIES UNDER THE 
              MEDICARE PROGRAM.

    (a) Coverage.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (n)--
                    (A) by inserting ``substitute disposable medical 
                technologies (as defined in subsection (iii)) and 
                services and supplies used in conjunction with such 
                technologies,'' after ``hospital beds,''; and
                    (B) by inserting ``(unless such equipment is a 
                substitute disposable medical technology or a service 
                or supply used in conjunction with such a technology)'' 
                after ``rental basis''; and
            (2) by adding at the end the following new subsection:

               ``Substitute Disposable Medical Technology

    ``(iii) The term `substitute disposable medical technology' means 
medical equipment that--
            ``(1) is primarily and customarily used to serve a medical 
        purpose;
            ``(2) would otherwise be covered as durable medical 
        equipment under this title but for the fact that such equipment 
        is not durable (as defined by the Secretary for purposes of 
        coverage of durable medical equipment under this title); and
            ``(3) the Secretary determines substitutes for durable 
        medical equipment.
In making the determination under paragraph (3), the Secretary shall 
consult with medical specialty societies, medical device manufacturers, 
patient groups, and other stakeholders as part of the annual rulemaking 
process for durable medical equipment under this title.''.
    (b) Payment Provisions.--Section 1834(a) of the Social Security Act 
(42 U.S.C. 1395m(a)) is amended by adding at the end the following new 
paragraph:
            ``(23) Special payment rule for substitute disposable 
        medical technologies.--Notwithstanding the preceding provisions 
        of this subsection, the Secretary shall determine the payment 
        amount under this subsection for a substitute disposable 
        medical technology (as defined in section 1861(iii)), and for 
        any related supplies and service fees incurred in conjunction 
        with the use and maintenance of such technology, in accordance 
        with the following:
                    ``(A) Single payment amount.--The Secretary shall 
                determine a single payment amount that shall be paid 
                for a substitute disposable medical technology and for 
                any related supplies and service fees incurred in 
                conjunction with the use and maintenance of such 
                technology. A payment for such a technology and for any 
                such related supplies and service fees made in the 
                amount of such single payment amount shall constitute 
                full payment under this title for such technology and 
                such related supplies and service fees.
                    ``(B) Calculation of payment amount.--The single 
                payment amount described in subparagraph (A) for a 
                substitute disposable medical technology and for any 
                related supplies and service fees incurred in 
                conjunction with the use and maintenance of such 
                technology shall be calculated by--
                            ``(i) calculating the sum of the amounts of 
                        payment that otherwise would be made under this 
                        section for--
                                    ``(I) the item of durable medical 
                                equipment for which the Secretary 
                                determines, pursuant to section 
                                1861(iii)(3), that such substitute 
                                disposable medical technology 
                                substitutes; and
                                    ``(II) all related supplies and 
                                service fees incurred in conjunction 
                                with the use and maintenance of such 
                                item of durable medical equipment;
                            ``(ii) calculating the amount that is 95 
                        percent of the sum calculated under clause (i); 
                        and
                            ``(iii) calculating the single payment 
                        amount for the substitute disposable medical 
                        technology and for any related supplies and 
                        service fees incurred in conjunction with the 
                        use and maintenance of such technology such 
                        that the sum of the payments under this 
                        subsection for--
                                    ``(I) all substitute disposable 
                                medical technologies that the Secretary 
                                determines, pursuant to section 
                                1861(iii)(3), will be necessary to 
                                provide a substitute for the item of 
                                durable medical equipment described in 
                                clause (i)(I); and
                                    ``(II) any related supplies and 
                                service fees incurred in conjunction 
                                with the use and maintenance of such 
                                technologies,
                        and is equal to the amount calculated under 
                        clause (ii). In making such calculation, the 
                        Secretary shall consult with medical specialty 
                        societies, medical device manufacturers, 
                        patient groups, and other stakeholders to 
                        ensure that an appropriate comparison is made 
                        that captures use of the various technologies 
                        (including related supplies, if any) over an 
                        average course of therapy for a typical 
                        patient.
                    ``(C) Lump-sum payment.--The single payment amount 
                described in subparagraph (A) for a substitute 
                disposable medical technology and for any related 
                supplies and service fees incurred in conjunction with 
                the use and maintenance of such technology shall be 
                made in a lump-sum amount.
                    ``(D) Payment for physicians' and hospital 
                outpatient department services.--Nothing in this 
                paragraph should be construed as limiting or changing 
                payment for items or services for which payment is made 
                under section 1848 or section 1833(t).''.
    (c) Conforming Amendment.--Section 1847(a)(7)(B) of the Social 
Security Act (42 U.S.C. 1395w-3(a)(7)(B)) is amended--
            (1) in clause (i), by striking ``and'' at the end;
            (2) in clause (ii), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following new clause:
                            ``(iii) that are substitute disposable 
                        medical technologies (as defined in section 
                        1861(iii)).''.
    (d) Effective Date.--The provisions of, and amendments made by, 
this section shall apply with respect to items and services furnished 
on or after January 1, 2016.
    (e) Rule of Construction; Implementation.--
            (1) Rule of construction.--Nothing in this section or the 
        amendments made by this section shall be construed as--
                    (A) affecting the ability of a physician (or any 
                other prescribing practitioner) to exercise their 
                judgment in prescribing or ordering for a Medicare 
                beneficiary appropriate durable medical equipment or 
                other medical device or technology for the treatment of 
                an illness, injury, or condition of the Medicare 
                beneficiary; or
                    (B) affecting the ability of the Medicare 
                beneficiary to access appropriate durable medical 
                equipment or other appropriate medical device or 
                technology for such treatment.
            (2) Implementation.--The Secretary shall implement the 
        provisions of, and amendments made by, this section in a manner 
        such that the methodologies for determining coverage of an item 
        of durable medical equipment (as defined in section 1861(n) of 
        the Social Security Act (42 U.S.C. 1395x(n))) (other than such 
        an item that is a substitute disposable medical technology (as 
        defined in section 1861(iii))) and the payment amount for the 
        item of durable medical equipment (other than such an item that 
        is a substitute disposable medical technology (as so defined)) 
        under section 1834 or 1847 of such Act (42 U.S.C. 1395m, 1395w-
        3), as the case may be, is not affected by the coverage of and 
        payment amount for a substitute disposable medical technology 
        under sections 1861(iii) and 1834(a)(23) of such Act, 
        respectively, as added by subsections (a) and (b), 
        respectively.
                                 <all>