,,ii  #aaeth ,,congress  #ast ,session  
,s4 #bage  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,november #cj1 
#bjag ,mr4 ,cassidy 7for himself1 ,mr4  
,manchin1 and ,mr4 ,grassley7 introduced
 the following bill2 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 ventilators1 and for other purposes4 
#a4 ,short title  ,this ,act may be     
cited as the ,beneficiary ,respiratory  
,equipment ,access and ,transparency to 
,home ,ventilator ,care ,act of #bjag or
 the ,,breath ,act of #bjag4  #b4       
,promoting evidence-based care for      
certain ventilators and other items of  
durable medical equipment ,section #ahcd
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #aciem7 is amended by adding  
at the end the following new subsection3
  7v7 ,appropriate use criteria for     
certain ventilators  7#a7 ,in general   
,not later than ,january #a1 #bjah1     

subject to paragraph 7#b71 and in       
consultation with medical experts and   
applicable stakeholders1 the ,secretary 
shall establish and implement policies  
and standards for determining the       
appropriate use of ventilators as       
described in subsection 7a77#c77;,a74   
7#b7 ,delay in implementation of        
appropriate use criteria for use by     
certain individuals ,the ,secretary may1
 as the ,secretary determines           
appropriate1 delay until such date as   
the ,secretary determines appropriate   
but not later than ,january #a1 #bjbj1  
the establishment and implementation of 
appropriate use criteria as described in
 paragraph 7#a7 7which may be the same  
appropriate use criteria established and
 implemented under such paragraph7 for  
ventilators furnished to individuals    
diagnosed with neuromuscular or other   
thoracic restrictive diseases or cystic 
fibrosis4  4  #c4 ,reimbursement for    
home mechanical ventilators  7a7 ,in    
general ,section #ahcd7;a77#c7 of the   

,social ,security ,act 7#db ,u4,s4,c4   
#aciem7a77#c77 is amended-- 7#a7 in     
subparagraph 7,b7--  7,a7 in clause     
7iii71 by striking and at the end2  7,b7
 in clause 7iv7--  7i7 by inserting 1   
except as provided in clause 7v71 after 
subsequent year2 and  7ii7 by striking  
the period at the end and inserting 2   
and2 and  7,c7 by adding at the end the 
following new clause3  7v7 for an item  
or device furnished on or after ,january
 #a1 #bjah1 in the case of a ventilator 
described in subparagraph 7,a71 the     
payment rate determined for the         
ventilator under subparagraph 7,d7 for  
the year4  2 and  7#b7 by adding at the 
end the following new subparagraphs3    
7,d7 #bjah and subsequent years payment 
rates for ventilators ,for purposes of  
subparagraph 7,b77v71 the payment rate  
determined under this subparagraph for a
 ventilator described in subparagraph   
7,a7 is the following3  7i7 #bjah ,for  
#bjah1 the payment amount specified in  
subparagraph 7,b7 for an item or device 

furnished on or after ,july #a1 #bjag1  
and before ,january #a1 #bjah1 increased
 by the covered item update for #bjah4  
7ii7 #bjai ,for #bjai1 the rate         
determined under clause 7i7 for #bjah-- 
7,i7 increased by the covered item      
update for #bjai2 and  7,,ii7 if        
applicable1 increased by the budget     
neutrality adjustment under subparagraph
 7,e74  7iii7 #bjbj and subsequent years
 ,for #bjbj and subsequent years1 the   
rate determined under this subparagraph 
for an item or device furnished on      
,december #ca of the previous year1     
increased by the covered item update for
 the year4  7,e7 ,budget neutrality     
adjustment of payment rates for         
ventilators for #bjai  7i7 ,in general  
,subject to the succeeding clauses of   
this subparagraph1 the ,secretary shall 
implement the provisions of             
subparagraphs 7,b77v7 and 7,d7 in a     
budget neutral manner and any budget    
neutrality adjustment under this        
subparagraph shall be limited to        

payments for a ventilator described in  
subparagraph 7,a7 furnished during      
#bjai4  7ii7 ,computation of aggregate  
budget neutrality adjustment ,the       
aggregate budget neutrality adjustment  
under this subparagraph shall be an     
amount equal to the difference 7if any7 
between--  7,i7 aggregate payments under
 this part for ventilators described in 
subparagraph 7,a7 furnished during      
#bjag1 as adjusted under subclause 7,i7 
of clause 7iii72 and  7,,ii7 aggregate  
payments under this part for such       
ventilators furnished during #bjah1 as  
adjusted under subclause 7,,ii7 of such 
clause4  7iii7 ,adjustments ,for        
purposes of clause 7ii7-- 7,i7 payments 
described in subclause 7,i7 of such     
clause shall be increased by the covered
 item update for #bjah2 and  7,,ii7     
payments described in subclause 7,,ii7  
of such clause shall be increased or    
decreased by the percentage change in   
the total number of individuals enrolled
 under this part 7other than ,medicare  

,advantage enrollees7 from #bjag to     
#bjah4  4