[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 3195 Introduced in Senate (IS)]

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114th CONGRESS
  2d Session
                                S. 3195

 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

                             July 13, 2016

  Mr. Cassidy (for himself 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 2016'' or the 
``BREATH Act of 2016''.

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

    Section 1834(a) of the Social Security Act (42 U.S.C. 1395(m)) is 
amended by adding at the end the following new subsection:
    ``(t) Appropriate Use Criteria for Certain Ventilators.--Not later 
than January 1, 2017, and in consultation with medical experts, the 
Secretary shall establish policies and standards for determining the 
appropriate use of ventilators as described in subsection (a)(3)(A).''.

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) in 2017 and each subsequent year, in 
                        the case of a ventilator described in 
                        subparagraph (A), the payment rate determined 
                        for the ventilator under subparagraph (D) for 
                        that year.''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Payment rates for ventilators.--For purposes 
                of subparagraph (B)(v), payment for a ventilator 
                described in subparagraph (A) shall be made as follows:
                            ``(i) 2017 payment rate.--For 2017, at a 
                        rate equal to 120 percent of the rate 
                        determined under subparagraph (B) for 2016, 
                        increased by the covered item update for the 
                        year.
                            ``(ii) 2018 payment rate.--For 2018, at the 
                        rate determined under this subparagraph for 
                        2017--
                                    ``(I) increased by the covered item 
                                update for the year;
                                    ``(II) increased or decreased, 
                                expressed as a percentage, by the 
                                difference between--
                                            ``(aa) the absolute 
                                        percentage difference in the 
                                        number of beneficiaries for 
                                        whom the program made payment 
                                        for the rental of such item or 
                                        device during 2017 and the 
                                        number of beneficiaries for 
                                        whom the program made payment 
                                        for the rental of the item or 
                                        device during 2015; and
                                            ``(bb) 20 percent; and
                                    ``(III) increased or decreased by 
                                the percentage change in the total 
                                number of Medicare beneficiaries in 
                                2015 as compared to 2017.
                            ``(iii) 2019 and subsequent years payment 
                        rate.--For 2019 and subsequent years, at the 
                        rate determined under this subparagraph for the 
                        previous year increased by the covered item 
                        update for the year.''.
    (b) Application.--The Secretary shall implement the provisions of, 
and amendments made by, this section in a budget neutral manner and any 
such budget neutrality adjustment shall be limited to payments for a 
ventilator described in section 1834(a)(3)(A) of the Social Security 
Act (42 U.S.C. 1395m(a)(3)(A)).
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