,,ii #aahth ,,congress #b;d ,session ,s4 #chba ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #bh1 #bjbd ,mr4 ,cassidy 7for himself1 ,mr4 ,warner1 and ,ms4 ,klobuchar7 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 improve the payment method for oxygen and oxygen related equipment1 supplies1 and services1 to increase beneficiary access to oxygen and oxygen related equipment1 supplies1 and services1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,supplemental ,oxygen ,access ,reform ,act of #bjbd or the ,,soar ,act of #bjbd4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,,title ,i--,protect ,beneficiary ,access to ,supplemental ,oxygen ,therapy in the ,home and ,community ,sec4 #aja4 ,reform of the ,medicare supplemental oxygen benefit4 ,sec4 #ajb4 ,establishment of supplemental oxygen responsibilities criteria4 ,sec4 #ajc4 ,technical corrections4 ,,title ,,ii--,protecting beneficiary access to respiratory therapists ,sec4 #bja4 ,reimbursement for respiratory therapists4 ,,title ,,iii--,adoption of electronic templates ,sec4 #cja4 ,use of electronic templates to document medical necessity and restoring clinical inference for oxygen and oxygen related equipment1 supplies1 and services4 ,,title ,,iv--,establishment of beneficiary rights ,sec4 #dja4 ,establishing protections for individuals receiving oxygen or oxygen related equipment1 supplies1 or services4 ,i ,protect ,beneficiary ,access to ,supplemental ,oxygen ,therapy in the ,home and ,community #aja4 ,reform of the medicare supplemental oxygen benefit 7a7 ,removing oxygen and oxygen related equipment1 supplies1 and services from competitive acquisition program ,to improve patient access to supplemental oxygen therapy ,section #ahdg7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#c77 is amended by-- 7#a7 inserting and exclusion after ,exception authority2 7#b7 by redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively1 and moving such clauses as so redesignated #b ems to the right2 7#c7 by striking ,in carrying out and inserting the following3 7,a7 ,in general ,in carrying out 2 and 7#d7 by adding at the end the following new subparagraph3 7,b7 ,exclusion of oxygen1 and oxygen related equipment1 supplies1 and services ,beginning on or after ,january #a1 #bjbe1 the ,secretary shall exclude oxygen and oxygen related equipment1 supplies1 and services from the competitive acquisition program under this section and payment for oxygen and oxygen related equipment1 supplies1 and services shall be made as prescribed under subparagraphs 7,e71 7,f71 and 7,h7 of section #ahcd7;a77#i74 4 7b7 ,establishing adequate payment for oxygen and oxygen related equipment1 supplies1 and services ,section #ahcd7;a77#i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77#i77 is amended-- 7#a7 in the first sentence of the matter preceding subparagraph 7,a71 by inserting the following before the period3 7for oxygen and oxygen equipment furnished before ,january #a1 #bjbe7 or the amount determined under subparagraph 7,e71 subject to subparagraphs 7,f71 7,g71 and 7,h7 7for oxygen and oxygen related equipment1 supplies1 and services furnished on or after ,january #a1 #bjbe722 and 7#b7 by adding at the end the following3 7,e7 ,payment for oxygen and oxygen related equipment1 supplies1 and services excluded from competitive acquisition program ,subject to subparagraphs 7,f71 7,g71 and 7,h7 in the case of oxygen and oxygen related equipment1 supplies1 and services furnished on or after ,january #a1 #bjbe-- 7i7 in areas that are competitive bidding areas in which a competitive bidding program is implemented for other covered items1 the payment amount is equal to-- 7,i7 for #bjbe1 the fee schedule amounts for the area for items and services in effect on ,december #ca1 #bjbd2 and 7,,ii7 for each subsequent year1 the amount determined under this clause for the preceding year1 increased by the percentage increase in the consumer price index for all urban consumers 7,united ,states city average7 for the #ab-month period ending on ,december #ca of the previous year2 7ii7 in rural areas and non-contiguous areas 7,alaska1 ,hawaii1 and ,u4,s4 territories71 the payment amount is equal to-- 7,i7 #ej percent of #aaj percent of the national average price for the item or service determined under section #dad4baj 7g77#a77;ii7 of title #db1 ,code of ,federal ,regulations2 and 7,,ii7 #ej percent of-- 7aa7 for #bjbe1 the fee schedule amount for the area in effect on ,december #ca1 #bjbd2 and 7bb7 for each subsequent year1 the amount determined under this subclause for the preceding year1 increased by the percentage increase in the consumer price index for all urban consumers 7,united ,states city average7 for the #ab-month period ending on ,december #ca of the previous year2 and 7iii7 in areas other than those described in clauses 7i7 and 7ii71 the payment amount is equal to the sum of #ge percent of the adjusted payment amount established under clause 7i7 and #be percent of the unadjusted fee schedule amount otherwise determined without taking into account this subparagraph4 7,f7 ,special rule for liquid oxygen 7i7 ,payment 7,i7 ,in general ,in lieu of the volume adjustment established under paragraph 7#e77;,c71 not later than ,january #a1 #bjbe1 the ,secretary in consultation with suppliers1 manufacturers1 patients and patient advocates1 and physicians1 and through notice-and-comment rulemaking1 shall establish a separate payment amount that meets the requirements of this subparagraph made to a supplier for the provision of liquid oxygen and liquid oxygen related equipment1 supplies1 and services that meets the requirements described in subparagraph 7,g74 7,,ii7 ,payment floor ,the payment amount established under subclause 7,i7 may not be less than an amount equal to #bjj percent of the #bjae ,durable ,medical ,equipment1 ,prosthetics_/,orthotics ,supplies ,fee ,schedule updated by the consumer price index for all urban consumers 7,united ,states city average7 for years #bjaf through #bjbd4 7,,iii7 ,update mechanism ,beginning on ,january #a1 #bjbf1 the payment amount described in subclause 7,i7 shall be increased annually by the projected percentage increase in the consumer price index for all urban consumers 7,united ,states city average7 for the #ab-month period ending ,december #ca of the previous year4 7ii7 ,considerations ,in implementing the payment amount under this subparagraph1 the ,secretary shall take into account the cost of liquid oxygen on a per pound basis1 the cost of liquid oxygen equipment1 the infrastructure costs associated with providing liquid oxygen equipment and supplies 7including labor1 storage1 transportation1 maintenance1 and similar costs71 the cost of complying with ,federal and ,state regulations specific to the delivery and transportation of liquid oxygen1 and any other cost factors the ,secretary deems appropriate after consulting with stakeholders such as suppliers1 providers1 patients and patient advocates1 and manufacturers4 7iii7 ,monthly add-on for high-flow patients 7,i7 ,in general ,subject to subclause 7,,ii71 the ,secretary shall establish a non-budget neutral add-on to the payment amount under clause 7i7 when the prescribing practitioner orders an oxygen flow rate equal to or greater than #f liters per minute4 7,,ii7 ,add-on amount ,the add-on amount shall equal the per pound cost of the oxygen exceeding the amount required to provide a liter flow that is equal to or greater than #f liters per minute4 7iv7 ,periodic assessment of the base rate ,the ,secretary shall assess at least once every #c years the adequacy of the payment amounts under this subparagraph on a cost-related basis or other economical and equitable basis4 7v7 ,transitional interim payment 7,i7 ,in general ,for items and services furnished on or after the date of the enactment of the ,,soar ,act of #bjbd and prior to the implementation of the payment amount established under this subparagraph1 the ,secretary shall adopt a transitional interim payment amount for liquid oxygen1 and liquid oxygen equipment1 supplies1 and services in an amount equal to #bjj percent of the #bjae ,durable ,medical ,equipment1 ,prosthetics_/,orthotics ,supplies ,fee ,schedule updated by the consumer price index for all urban consumers 7,united ,states city average7 for years #bjaf through #bjbd4 7,,ii7 ,update ,this amount shall be updated annually by the projected percentage change in the consumer price index for all urban consumers 7,united ,states city average7 for the #ab-month period ending on ,december #ca of the previous year1 until the ,secretary implements the payment amount under this subparagraph4 7vi7 ,coverage criteria 7,i7 ,in general ,not later than ,january #a1 #bjbe1 the ,secretary1 in consultation with stakeholders1 shall establish objective clinical criteria for the coverage of liquid oxygen1 and liquid oxygen equipment1 supplies1 and services under this title4 7,,ii7 ,update of criteria ,the ,secretary shall review and update the coverage standards under this clause every #e years to ensure the standards take into consideration current medical and clinical guidelines and take into effect modality in order to maximize beneficiary independence4 4 #ajb4 ,establishment of supplemental oxygen responsibilities criteria 7a7 ,in general #ahcd7;a77#i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77#i771 as amended by section #aja7;b71 is further amended by inserting the following new subparagraph3 7,g7 ,oxygen and oxygen related equipment1 supplies1 and services ,in consultation with stakeholders1 the ,secretary shall define the scope of services a supplier of oxygen and oxygen related equipment1 supplies1 and services must provide to receive payment under this part1 to include-- 7i7 conducting an initial evaluation of the beneficiary using the uniform oxygen patient evaluation form described in paragraph 7#e77;,g7 to determine the appropriate use of oxygen and oxygen related equipment1 supplies1 and services by the beneficiary1 including the use of portable equipment2 7ii7 ensuring the beneficiary has appropriate access to portable oxygen1 and portable oxygen equipment1 supplies1 and services based on the mobility needs of the beneficiary1 including the needs of the beneficiary outside the home of the beneficiary2 7iii7 providing written and verbal beneficiary and caregiver education regarding oxygen and oxygen related equipment1 supplies1 and services1 stationary and portable options1 and oxygen safety1 which includes evaluating the environment of the beneficiary for safety risks or hazards1 such as fire and fall hazards2 7iv7 providing appropriate delivery1 set-up1 and coordination of oxygen services 7including the delivery of any oxygen equipment or supplies to a beneficiary prior to such beneficiary being discharged1 delivering such equipment1 and setting up the equipment71 as needed1 in a timely manner as agreed upon by the beneficiary or caregiver1 supplier1 and prescribing practitioner2 7v7 evaluating the ability of the beneficiary to operate the equipment safely and effectively2 7vi7 providing infection control information and instructions about all equipment and supplies2 7vii7 providing equipment-related services1 including checking oxygen system purity levels and flow rates1 changing and cleaning filters1 and assuring the integrity of alarms and back-up systems1 consistent with the manufacturer specifications and in accordance with all ,federal1 ,state1 and local laws and regulations2 7viii7 monitoring visits when necessary by appropriate personnel1 including a respiratory therapist to evaluate all aspects of the services being provided to the beneficiary by the provider2 7ix7 documenting exception reporting by the supplier to the prescribing physician when changes occur in the compliance of the beneficiary with the beneficiary's plan of care2 7x7 providing1 as needed1 continued education to the beneficiary or caregiver regarding appropriate oxygen equipment maintenance practices and performance2 7xi7 providing1 as prescribed by the plan of care of the prescribing practitioner1 appropriate oxygen and oxygen related equipment1 supplies1 and services 7including supplemental supplies and emergency oxygen back-ups as appropriate72 7xii7 ensuring oxygen and oxygen equipment can be used appropriately outside the home of a beneficiary based on necessity2 7xiii7 providing #bd-;hour on-call coverage to respond to beneficiary needs relating to oxygen and oxygen related equipment1 supplies1 and services2 and 7xiv7 assisting the beneficiary with the coordination of oxygen and oxygen related equipment1 supplies1 and services1 including by assisting the beneficiary find a different supplier if the beneficiary temporarily travels outside of the service area of the supplier4 ,if the beneficiary relocates permanently1 the new supplier caring for the beneficiary will assume responsibility for billing the ,medicare program directly4 4 7b7 ,effective date ,the amendment made by this section shall take effect on the date that is #a year after the date of enactment of this ,act4 #ajc4 ,technical corrections ,section #ahfa7n7 is amended by striking iron lungs1 oxygen tents and inserting oxygen and oxygen related equipment1 supplies1 and services4 ,,ii ,protecting beneficiary access to respiratory therapists #bja4 ,reimbursement for respiratory therapists 7a7 ,protecting access to respiratory therapist services 7#a7 ,adding respiratory therapist services to the definition of medical and other health services ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7,a7 in subparagraph 7,,jj71 by inserting and after the semicolon2 and 7,b7 by adding at the end the following new subparagraph3 7,,kk7 respiratory therapist services 7as defined in subsection 7nnn77 furnished on or after ,january #a1 #bjbe4 4 7#b7 ,definition of respiratory therapist services ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsection3 7nnn7 ,respiratory therapist services ,the term respiratory therapist services means services performed by a respiratory therapist within the scope of practice of a respiratory therapist as defined by ,state law1 regulations1 and applicable accreditation standards for the assessment1 treatment1 and monitoring of patients requiring oxygen and oxygen related equipment1 supplies1 or services4 4 7b7 ,add-,on payment adjustment ,section #ahcd7;a77#i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77#i771 as amended by sections #aja7;b7 and #ajb7;a71 is further amended by adding at the end the following new subparagraph3 7,h7 ,monthly payment add-on adjustment for respiratory therapist services ,for respiratory therapist services furnished on or after ,january #a1 #bjbe1 the ,secretary shall implement through notice and comment rulemaking and in consultation with stakeholders a non-budget neutral add-on payment adjustment to the payment amount established under this paragraph that reflects the cost of providing respiratory therapist services as clinically appropriate under ,state law4 4 ,,iii ,adoption of electronic templates #cja4 ,use of electronic templates to document medical necessity and restoring clinical inference for oxygen and oxygen related equipment1 supplies1 and services 7a7 ,adopting electronic templates for determining medical necessity ,section #ahcd7;a77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77#e77 is amended by adding at the end the following3 7,g7 ,adoption of electronic templates to document medical necessity 7i7 ,in general ,for any oxygen and oxygen related equipment1 supplies or service1 including liquid oxygen1 furnished on or after ,january #a1 #bjbe1 the ,secretary shall adopt a template in an electronic format that meets the requirements of clause 7ii7 to be completed by the prescribing practitioner 7as defined by the ,secretary7 that shall constitute the complete request for information to determine whether payment for such service1 equipment1 or supplies is covered by this title and is reasonable and necessary for the diagnosis or treatment of illness or injury 7under section #ahfb7;a77#a77;,a774 7ii7 ,template requirements ,the template shall require the prescribing practitioner to provide each of the following3 7,i7 ,documentation that the beneficiary was seen by a prescribing practitioner within the appropriate timeframes for certification of the need for the services1 equipment1 or supplies4 7,,ii7 ,documentation of the qualifying blood gas or saturation test results4 7,,iii7 ,documentation indicating that the beneficiary needs or is using the appropriate equipment1 supplies1 and services4 7,,iv7 ,any other documentation determined appropriate by the ,secretary1 except the ,secretary shall not require the prescribing practitioner to provide medical record notes regarding the beneficiary4 7iii7 ,contractor adjudication ,the ,secretary shall require ,medicare administrative contractors to adjudicate claims for payment for oxygen and oxygen related equipment1 supplies1 and services using electronic transactions4 7,h7 ,restoration of clinical inference and judgment ,for claims submitted on or after the date of enactment of this subparagraph with respect to the conduct of payment audits of suppliers of oxygen and oxygen related equipment1 supplies1 and services under this part the ,secretary shall use clinical inference and clinical judgment in the evaluation of templates1 medical records1 and orders when conducting such audits in the same manner as the ,secretary interpreted and applied such clinical judgment to claim reviews before #bjji pursuant to the ,secretary's instruction to contractors4 4 ,,iv ,establishment of beneficiary rights #dja4 ,establishing protections for individuals receiving oxygen or oxygen related equipment1 supplies1 or services ,section #ahcd7;a77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77#e771 as amended by section #cja1 is further amended by adding at the end the following new subparagraph3 7,i7 ,establishing protections for individuals receiving oxygen or oxygen related equipment1 supplies1 or services ,the ,secretary shall establish through regulation protections for any individual receiving oxygen or oxygen related equipment1 supplies1 or services under this part where such individual shall have the right to-- 7i7 choose the local supplier of such services from among qualified suppliers and to change such supplier2 7ii7 receive communications from the supplier in a clear and understandable manner2 7iii7 ensure privacy and confidentiality in all aspects of treatment and the personal health information of such individual consistent with ,federal and ,state laws2 7iv7 be informed by the supplier of such services about all aspects of the services being furnished by such supplier and be informed of the right to refuse treatment1 to discontinue treatment1 and to refuse to participate in experimental research2 7v7 be informed by the supplier of policies and expectations of the supplier regarding patient conduct and responsibilities2 7vi7 be informed by the supplier about treatment modalities and categories of equipment relating to oxygen services for use by the individual and offered by the supplier2 7vii7 be informed by the supplier of the policies of such supplier regarding #bd-;hour on-call coverage2 7viii7 be informed by the supplier of the financial responsibilities of the individual with regard to such services2 7ix7 be provided with the appropriate gaseous or liquid oxygen equipment1 supplies1 and services to ensure the mobility of the beneficiary1 as well as the clinically appropriate amount of oxygen and oxygen related equipment1 supplies1 and services as agreed upon by the individual 7or the individual's representative71 the supplier1 and the prescribing practitioner2 7x7 receive equipment that is maintained to the guidelines of the manufacturer2 7xi7 have broken or faulty equipment repaired or replaced in a timely manner2 7xii7 have oxygen or oxygen related equipment or supplies delivered by the supplier and to be contacted consistent with the requirements of section #daj4ch of title #db1 ,code of ,federal ,regulations2 7xiii7 be informed by the supplier of any potential changes to the equipment1 supplies1 or services of the individual and the right to consult with the prescribing practitioner of the individual regarding such changes to ensure they are appropriate and necessary and to be informed of the exceptions1 as specified by the ,secretary1 when a supplemental oxygen services supplier may change the oxygen equipment of the individual2 7xiv7 be informed by the supplier of the internal and external grievance processes of the supplier 7as well as how to contact ,medicare through a hotline or beneficiary ombudsman71 which shall include the right of an individual to file1 personally or through a representative of the individual's choosing1 an internal or external grievance without retaliation or denial of services2 7xv7 in the case of a supplier involuntary discharging an individual-- 7,i7 receive from such supplier a written notice that is provided to the individual no later than #cj days in advance of the involuntary discharge of the individual2 and 7,,ii7 have such supplier-- 7aa7 follow established involuntary discharge procedures2 or 7bb7 in the case of an immediate threat to the health and safety of others1 follow an abbreviated involuntary discharge procedure2 7xvi7 be assisted by the supplier in obtaining the oxygen equipment and supplies prescribed by the treating physician of the individual when the individual is traveling2 7xvii7 receive from the supplier oxygen supplies1 refills1 and emergency back-up equipment1 as appropriate2 and 7xviii7 be informed of a plan by the supplier in case of a power outage or other natural emergency1 so that the individual will continue to receive the necessary oxygen supplies and equipment4 4