,,ii  #aad? ,,congress  #a/ ,session    
,s4 #bcab  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,novemb] #ai1 #bjae    
,mr4 ,?une 7= himself1 ,ms4 ,heitkamp1  
,mr4 ,rob]ts1 ,mr4 ,k+1 ,mr4 ,crapo1    
,ms4 ,coll9s1 & ,mrs4 ,capito7 introduc$
 ! foll[+ bill2 :i* 0 read twice &      
ref]r$ to ! ,committee on ,f9ance  ,a   
,,bill  ,to am5d titles ,,xviii & ,,xix 
( ! ,social ,security ,act to make      
improvem5ts to paym5ts = durable m$ical 
equipm5t "u ! ,m$ic>e & ,m$icaid        
programs4  #a4 ,%ort title  ,?is ,act   
may be cit$ z ! ,,dme ,access &         
,/abilization ,act ( #bjae4  #b4        
,revision ( paym5ts = durable m$ical    
equipm5t "u ! ,m$ic>e program  7a7      
,transition to implem5tation ( fee      
s*$ule paym5t adju/m5ts us+ in=mation f 
competitive bidd+ programs ,section     
#ahcd7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciem7a77#a77 is am5d$ 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,j7 ,transition to       
implem5tation ( paym5t adju/m5ts us+    

in=mation f competitive bidd+ programs  
7i7 ,9 g5]al ,9 implem5t+ subp>agraph   
7,f7 & p>agraphs 7#a7 & 7#b7 ( section  
#dad4baj7;g7 ( title #db1 ,code ( ,f$]al
 ,regulations ) respect to items &      
s]vices furni%$ on or aft] ,janu>y #a1  
#bjaf1 & be=e ,janu>y #a1 #bjai1 ! fee  
s*$ule am\nt t w\ld o!rwise be det]m9$ =
 ea* area "u ?is section %all be adju/$ 
to ! less] (--  7,i7 ! applicable p]c5t 
( ! regional price det]m9$ "u clause 7i7
 ( su* p>agraph 7#a7 = ! region 9 :i*   
su* area is locat$2 &  7,,ii7 ! fee     
s*$ule am\nt t w\ld o!rwise be det]m9$ =
 su* area "u ?is section on ,janu>y #a1 
#bjae1 updat$ by ! cov]$ item update    
describ$ 9 p>agraph 7#ad77,l7 = ! ye> 9 
:i* ! items & s]vices to :i* su* fee    
s*$ule applies are furni%$4  7ii7       
,applicable p]c5t ,= purposes ( clause  
7i77,i71 ! t]m applicable p]c5t means-- 
7,i7 = an area def9$ z a rural area =   
purposes ( su* section #dad4baj7;g7 or  
an area 9 a fronti] ,/ate 7z def9$ 9    
section #ahhf7;d77#c77;,e77iii77,,ii771 

#acj p]c5t2 &  7,,ii7 = any o!r area1   
#abj p]c5t4  7iii7 ,phase-9 ,! adju/m5t 
describ$ 9 clause 7i7 %all be implem5t$ 
ov] a two-ye> p]iod & 9 a mann] t phases
 9 su* adju/m5t 9 equal increm5ts 9 ea* 
ye> ( su* two-ye> p]iod1 ) su* adju/m5t 
be+ fully implem5t$ ) respect to items &
 s]vices furni%$ 9 #bjag4  4  7b7 ,bid  
ceil+ = competitive acquisition =       
durable m$ical equipm5t "u ! ,m$ic>e    
program ,section #ahdg7;b77#e7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#c7;b77#e77 is am5d$-- 7#a7 9    
subp>agraph 7,a7--  7,a7 by ins]t+ 1    
subject to subp>agraph 7,e71 aft]       
subsection 7a77#b72 &  7,b7 by ins]t+ 1 
subject to subp>agraph 7,e71 aft] ,bas$ 
on su* bids2 &  7#b7 by add+ at ! end ! 
foll[+ new subp>agraph3  7,e7 ,bid ceil+
 = durable m$ical equipm5t ,9 ! case (  
cov]$ items 7z def9$ 9 section          
#ahcd7;a77#ac77 = :i* paym5t w\ld       
o!rwise be made "u section #ahcd7;a7 t  
are furni%$ ) respect to competitive bid
 contracts t beg9 on or aft] ,janu>y #a1

 #bjai1 ! ,secret>y may n e/abli% a     
ceil+ on bids submitt$ "u ?is section = 
su* items t is less ?an ! am\nt t w\ld  
o!rwise be paid = su* items "u section  
#ahcd 7)\t ! application ( subsection   
7a77#a77;,f7 ( su* section7 on ,janu>y  
#a1 #bjae1 updat$ by ! cov]$ item update
 describ$ 9 subsection 7a77#ad77,l7 (   
su* section = ! ye> 9 :i* su* cov]$ item
 is furni%$4  4  7c7 ,requirem5ts 9     
det]m9+ adju/m5ts us+ in=mation f       
competitive bidd+ programs ,section     
#ahcd7;a77#a77;,g7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciem7a77#a77;,g77
 is am5d$ by add+ at ! end ! foll[+ new 
s5t5ce3 ,9 ! case ( items & s]vices     
furni%$ on or aft] ,janu>y #a1 #bjai1 9 
mak+ any adju/m5ts "u clause 7ii7 or    
7iii7 ( subp>agraph 7,f71 ! ,secret>y   
%all solicit & receive /akehold] input &
 %all also take into acc\nt ! av]age    
travel di/ance & co/ associat$ ) furni%+
 items & s]vices 9 a competitive        
acquisition area1 ! av]age volume (     
items & s]vices furni%$ by provid]s 9   

su* an area1 ! cle>+ price ( items &    
s]vices1 & ! numb] ( provid]s 9         
competitive acquisition areas comp>$ to 
! numb] ( provid]s 9 non-competitive    
acquisition areas44  #c4 ,limit+ ,f$]al 
,m$icaid reimbursem5t to ,/ates =       
durable m$ical equipm5t 7,,dme7 to      
,m$ic>e paym5t rates  7a7 ,m$icaid      
reimbursem5t  7#a7 ,9 g5]al ,section    
#aijc7;i7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;b7i77 is am5d$--   
7,a7 9 p>agraph 7#be71 by /rik+ or at ! 
end2  7,b7 9 p>agraph 7#bf71 by /rik+ ! 
p]iod at ! end & ins]t+ 2 or2 &  7,c7 by
 ins]t+ aft] p>agraph 7#bf7 ! foll[+ new
 p>agraph3  7#bg7 ) respect to any      
am\nts exp5d$ by ! ,/ate on ! basis ( a 
fee s*$ule = items describ$ 9 section   
#ahfa7n71 z det]m9$ 9 ! aggregate )     
respect to ea* class ( su* items z def9$
 by ! ,secret>y1 9 excess ( ! aggregate 
am\nt1 if any1 t w\ld be paid = su*     
items )9 su* class on a fee-=-s]vice    
basis "u ! program "u "p ,b ( title     
,,xviii1 includ+1 z applicable1 "u a    

competitive acquisition program "u      
section #ahdg 9 an area ( ! ,/ate4  4   
7#b7 ,effective date ,! am5dm5ts made by
 ?is subsection %all be effective )     
respect to paym5ts = items furni%$ on or
 aft] ,janu>y #a1 #bjbj4  7b7 ,m$ic>e   
,b5efici>y ,ombudsman ,section #ahjh7;c7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;b7c77 is am5d$ by add+  
at ! end ! foll[+ new p>agraph3  7#d7   
,monitor+ ,,dme reimbursem5t "u ,m$icaid
 ,! ,m$ic>e ,b5efici>y ,ombudsman %all  
evaluate ! impact ( ! competitive       
acquisition program "u section #ahdg1   
includ+ z appli$ "u section             
#aijc7;i77#bg71 on b5efici>y heal? /atus
 & heal? outcomes4  4