,,ii  #aae? ,,congress  #a/ ,session    
,s4 #bage  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,novemb] #cj1 #bjag    
,mr4 ,cassidy 7= himself1 ,mr4 ,man*91 &
 ,mr4 ,grassley7 introduc$ ! foll[+     
bill2 :i* 0 read twice & ref]r$ to !    
,committee on ,f9ance  ,a ,,bill  ,to   
am5d title ,,xviii ( ! ,social ,security
 ,act to pres]ve ,m$ic>e b5efici>y      
access to v5tilators1 & = o!r purposes4 
#a4 ,%ort title  ,?is ,act may be cit$ z
 ! ,b5efici>y ,respiratory ,equipm5t    
,access & ,transp>5cy to ,home          
,v5tilator ,c>e ,act ( #bjag or !       
,,brea? ,act ( #bjag4  #b4 ,promot+     
evid5ce-bas$ c>e = c]ta9 v5tilators &   
o!r items ( durable m$ical equipm5t     
,section #ahcd ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by 
add+ at ! end ! foll[+ new subsection3  
7v7 ,appropriate use crit]ia = c]ta9    
v5tilators  7#a7 ,9 g5]al ,n lat] ?an   
,janu>y #a1 #bjah1 subject to p>agraph  
7#b71 & 9 consultation ) m$ical exp]ts &
 applicable /akehold]s1 ! ,secret>y %all

 e/abli% & implem5t policies & /&>ds =  
det]m9+ ! appropriate use ( v5tilators z
 describ$ 9 subsection 7a77#c77;,a74    
7#b7 ,delay 9 implem5tation (           
appropriate use crit]ia = use by c]ta9  
individuals ,! ,secret>y may1 z !       
,secret>y det]m9es appropriate1 delay   
until su* date z ! ,secret>y det]m9es   
appropriate b n lat] ?an ,janu>y #a1    
#bjbj1 ! e/abli%m5t & implem5tation (   
appropriate use crit]ia z describ$ 9    
p>agraph 7#a7 7:i* may be ! same        
appropriate use crit]ia e/abli%$ &      
implem5t$ "u su* p>agraph7 = v5tilators 
furni%$ to individuals diagnos$ )       
neuromuscul> or o!r ?oracic re/rictive  
diseases or cy/ic fibrosis4  4  #c4     
,reimbursem5t = home me*anical          
v5tilators  7a7 ,9 g5]al ,section       
#ahcd7;a77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciem7a77#c77 is       
am5d$-- 7#a7 9 subp>agraph 7,b7--  7,a7 
9 clause 7iii71 by /rik+ & at ! end2    
7,b7 9 clause 7iv7--  7i7 by ins]t+ 1   
except z provid$ 9 clause 7v71 aft]     

subsequ5t ye>2 &  7ii7 by /rik+ ! p]iod 
at ! end & ins]t+ 2 &2 &  7,c7 by add+  
at ! end ! foll[+ new clause3  7v7 = an 
item or device furni%$ on or aft]       
,janu>y #a1 #bjah1 9 ! case ( a         
v5tilator describ$ 9 subp>agraph 7,a71 !
 paym5t rate det]m9$ = ! v5tilator "u   
subp>agraph 7,d7 = ! ye>4  2 &  7#b7 by 
add+ at ! end ! foll[+ new subp>agraphs3
  7,d7 #bjah & subsequ5t ye>s paym5t    
rates = v5tilators ,= purposes (        
subp>agraph 7,b77v71 ! paym5t rate      
det]m9$ "u ?is subp>agraph = a v5tilator
 describ$ 9 subp>agraph 7,a7 is !       
foll[+3  7i7 #bjah ,= #bjah1 ! paym5t   
am\nt specifi$ 9 subp>agraph 7,b7 = an  
item or device furni%$ on or aft] ,july 
#a1 #bjag1 & be=e ,janu>y #a1 #bjah1    
increas$ by ! cov]$ item update = #bjah4
  7ii7 #bjai ,= #bjai1 ! rate det]m9$ "u
 clause 7i7 = #bjah-- 7,i7 increas$ by !
 cov]$ item update = #bjai2 &  7,,ii7 if
 applicable1 increas$ by ! budget       
neutrality adju/m5t "u subp>agraph 7,e74
  7iii7 #bjbj & subsequ5t ye>s ,= #bjbj 

& subsequ5t ye>s1 ! rate det]m9$ "u ?is 
subp>agraph = an item or device furni%$ 
on ,decemb] #ca ( ! previ\s ye>1        
increas$ by ! cov]$ item update = ! ye>4
  7,e7 ,budget neutrality adju/m5t (    
paym5t rates = v5tilators = #bjai  7i7  
,9 g5]al ,subject to ! succe$+ clauses (
 ?is subp>agraph1 ! ,secret>y %all      
implem5t ! provisions ( subp>agraphs    
7,b77v7 & 7,d7 9 a budget neutral mann] 
& any budget neutrality adju/m5t "u ?is 
subp>agraph %all be limit$ to paym5ts = 
a v5tilator describ$ 9 subp>agraph 7,a7 
furni%$ dur+ #bjai4  7ii7 ,computation (
 aggregate budget neutrality adju/m5t ,!
 aggregate budget neutrality adju/m5t "u
 ?is subp>agraph %all be an am\nt equal 
to ! diff]5ce 7if any7 betwe5--  7,i7   
aggregate paym5ts "u ?is "p = v5tilators
 describ$ 9 subp>agraph 7,a7 furni%$    
dur+ #bjag1 z adju/$ "u subclause 7,i7 (
 clause 7iii72 &  7,,ii7 aggregate      
paym5ts "u ?is "p = su* v5tilators      
furni%$ dur+ #bjah1 z adju/$ "u         
subclause 7,,ii7 ( su* clause4  7iii7   

,adju/m5ts ,= purposes ( clause 7ii7--  
7,i7 paym5ts describ$ 9 subclause 7,i7 (
 su* clause %all be increas$ by ! cov]$ 
item update = #bjah2 &  7,,ii7 paym5ts  
describ$ 9 subclause 7,,ii7 ( su* clause
 %all be increas$ or decreas$ by !      
p]c5tage *ange 9 ! total numb] (        
individuals enroll$ "u ?is "p 7o!r ?an  
,m$ic>e ,advantage enrollees7 f #bjag to
 #bjah4  4