[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1406 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 1406
To amend title XVIII of the Social Security Act to improve the payment
method for oxygen and oxygen related equipment, supplies, and services,
to increase beneficiary access to oxygen and oxygen related equipment,
supplies, and services, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 10, 2025
Mr. Cassidy (for himself, Ms. Klobuchar, and Mr. Warner) 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 improve the payment
method for oxygen and oxygen related equipment, supplies, and services,
to increase beneficiary access to oxygen and oxygen related equipment,
supplies, and services, 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Supplemental
Oxygen Access Reform Act of 2025'' or the ``SOAR Act of 2025''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--PROTECT BENEFICIARY ACCESS TO SUPPLEMENTAL OXYGEN THERAPY IN
THE HOME AND COMMUNITY
Sec. 101. Reform of the medicare supplemental oxygen benefit.
Sec. 102. Establishment of supplemental oxygen responsibilities
criteria.
Sec. 103. Technical corrections.
TITLE II--PROTECTING BENEFICIARY ACCESS TO RESPIRATORY THERAPISTS
Sec. 201. Reimbursement for respiratory therapists.
TITLE III--ADOPTION OF ELECTRONIC TEMPLATES TO STRENGTHEN FRAUD AND
ABUSE PROTECTIONS AND ENSURE PROGRAM INTEGRITY
Sec. 301. Strengthening program integrity through the use of electronic
templates to document medical necessity,
and restoring clinical inference for oxygen
and oxygen related equipment, supplies, and
services.
Sec. 302. Establishing notice requirements for individuals receiving
oxygen or oxygen related equipment,
supplies, or services.
TITLE IV--ESTABLISHMENT OF BENEFICIARY RIGHTS
Sec. 401. Establishing protections for individuals receiving oxygen or
oxygen related equipment, supplies, or
services.
TITLE I--PROTECT BENEFICIARY ACCESS TO SUPPLEMENTAL OXYGEN THERAPY IN
THE HOME AND COMMUNITY
SEC. 101. REFORM OF THE MEDICARE SUPPLEMENTAL OXYGEN BENEFIT.
(a) Removing Oxygen and Oxygen Related Equipment, Supplies, and
Services From Competitive Acquisition Program To Improve Patient Access
to Supplemental Oxygen Therapy.--Section 1847(a)(3) of the Social
Security Act (42 U.S.C. 1395w-3(a)(3)) is amended by--
(1) inserting ``and exclusion'' after ``exception
authority'';
(2) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii), respectively, and moving such clauses as so
redesignated 2 ems to the right;
(3) by striking ``In carrying out'' and inserting the
following:
``(A) In general.--In carrying out''; and
(4) by adding at the end the following new subparagraph:
``(B) Exclusion of oxygen, and oxygen related
equipment, supplies, and services.--Beginning on or
after January 1, 2026, the Secretary shall exclude
oxygen and oxygen related equipment, supplies, and
services from the competitive acquisition program under
this section and payment for oxygen and oxygen related
equipment, supplies, and services shall be made as
prescribed under subparagraphs (E), (F), and (H) of
section 1834(a)(9).''.
(b) Establishing Adequate Payment for Oxygen and Oxygen Related
Equipment, Supplies, and Services.--Section 1834(a)(9) of the Social
Security Act (42 U.S.C. 1395m(a)(9)) is amended--
(1) in the first sentence of the matter preceding
subparagraph (A), by inserting the following before the period:
``(for oxygen and oxygen equipment furnished before January 1,
2026) or the amount determined under subparagraph (E), subject
to subparagraphs (F), (G), and (H) (for oxygen and oxygen
related equipment, supplies, and services furnished on or after
January 1, 2026);''; and
(2) by adding at the end the following:
``(E) Payment for oxygen and oxygen related
equipment, supplies, and services excluded from
competitive acquisition program.--Subject to
subparagraphs (F), (G), and (H) in the case of oxygen
and oxygen related equipment, supplies, and services
furnished on or after January 1, 2026--
``(i) in areas that are competitive bidding
areas in which a competitive bidding program is
implemented for other covered items, the
payment amount is equal to--
``(I) for 2026, the fee schedule
amounts for the area for items and
services in effect on December 31,
2025; and
``(II) for each subsequent year,
the amount determined under this clause
for the preceding year, increased by
the percentage increase in the consumer
price index for all urban consumers
(United States city average) for the
12-month period ending on December 31
of the previous year;
``(ii) in rural areas and non-contiguous
areas (Alaska, Hawaii, and United States
territories), the payment amount is equal to--
``(I) 50 percent of 110 percent of
the national average price for the item
or service determined under section
414.210(g)(1)(ii) of title 42, Code of
Federal Regulations; and
``(II) 50 percent of--
``(aa) for 2026, the fee
schedule amount for the area in
effect on December 31, 2025;
and
``(bb) for each subsequent
year, the amount determined
under this subclause for the
preceding year, increased by
the percentage increase in the
consumer price index for all
urban consumers (United States
city average) for the 12-month
period ending on December 31 of
the previous year; and
``(iii) in areas other than those described
in clauses (i) and (ii), the payment amount is
equal to the sum of 75 percent of the adjusted
payment amount established under clause (i) and
25 percent of the unadjusted fee schedule
amount otherwise determined without taking into
account this subparagraph.
``(F) Special rule for liquid oxygen.--
``(i) Payment.--
``(I) In general.--In lieu of the
volume adjustment established under
paragraph (5)(C), not later than
January 1, 2026, the Secretary in
consultation with suppliers,
manufacturers, patients and patient
advocates, and physicians, and through
notice-and-comment rulemaking, 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 equipment, supplies, and
services that meets the requirements
described in subparagraph (G).
``(II) Payment floor.--The payment
amount established under subclause (I)
may not be less than an amount equal to
200 percent of the 2015 Durable Medical
Equipment, Prosthetics/Orthotics &
Supplies Fee Schedule updated by the
consumer price index for all urban
consumers (United States city average)
for years 2016 through 2025.
``(III) Update mechanism.--
Beginning on January 1, 2027, the
payment amount described in subclause
(I) shall be increased annually by the
projected percentage increase in the
consumer price index for all urban
consumers (United States city average)
for the 12-month period ending December
31 of the previous year.
``(ii) Considerations.--In implementing the
payment amount under this subparagraph, the
Secretary shall take into account the cost of
liquid oxygen on a per pound basis, the cost of
liquid oxygen equipment, the infrastructure
costs associated with providing liquid oxygen
equipment and supplies (including labor,
storage, transportation, maintenance, and
similar costs), the cost of complying with
Federal and State regulations specific to the
delivery and transportation of liquid oxygen,
and any other cost factors the Secretary deems
appropriate after consulting with stakeholders
such as suppliers, providers, patients and
patient advocates, and manufacturers.
``(iii) Monthly add-on for high-flow
patients.--
``(I) In general.--Subject to
subclause (II), the Secretary shall
establish a non-budget neutral add-on
to the payment amount under clause (i)
when the prescribing practitioner
orders an oxygen flow rate equal to or
greater than 6 liters per minute.
``(II) 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 6 liters
per minute.
``(iv) Periodic assessment of the base
rate.--The Secretary shall assess at least once
every 3 years the adequacy of the payment
amounts under this subparagraph on a cost-
related basis or other economical and equitable
basis.
``(v) Transitional interim payment.--
``(I) In general.--For items and
services furnished on or after the date
of the enactment of the SOAR Act of
2025 and prior to the implementation of
the payment amount established under
this subparagraph, the Secretary shall
adopt a transitional interim payment
amount for liquid oxygen, and liquid
oxygen equipment, supplies, and
services in an amount equal to 200
percent of the 2015 Durable Medical
Equipment, Prosthetics/Orthotics &
Supplies Fee Schedule updated by the
consumer price index for all urban
consumers (United States city average)
for years 2016 through 2025.
``(II) Update.--This amount shall
be updated annually by the projected
percentage change in the consumer price
index for all urban consumers (United
States city average) for the 12-month
period ending on December 31 of the
previous year, until the Secretary
implements the payment amount under
this subparagraph.
``(vi) Coverage criteria.--
``(I) In general.--Not later than
January 1, 2026, the Secretary, in
consultation with stakeholders, shall
establish objective clinical criteria
for the coverage of liquid oxygen, and
liquid oxygen equipment, supplies, and
services under this title.
``(II) Update of criteria.--The
Secretary shall review and update the
coverage standards under this clause
every 5 years to ensure the standards
take into consideration current medical
and clinical guidelines and take into
effect modality in order to maximize
beneficiary independence.''.
SEC. 102. ESTABLISHMENT OF SUPPLEMENTAL OXYGEN RESPONSIBILITIES
CRITERIA.
(a) In General.--Section 1834(a)(9) of the Social Security Act (42
U.S.C. 1395m(a)(9)), as amended by section 101(b), is further amended
by inserting the following new subparagraph:
``(G) Oxygen and oxygen related equipment,
supplies, and services.--In consultation with
stakeholders, the Secretary shall define the scope of
services a supplier of oxygen and oxygen related
equipment, supplies, and services must provide to
receive payment under this part, to include--
``(i) conducting an initial evaluation of
the beneficiary using the uniform oxygen
patient evaluation form described in paragraph
(5)(G) to determine the appropriate use of
oxygen and oxygen related equipment, supplies,
and services by the beneficiary, including the
use of portable equipment;
``(ii) ensuring the beneficiary has
appropriate access to portable oxygen, and
portable oxygen equipment, supplies, and
services based on the mobility needs of the
beneficiary, including the needs of the
beneficiary outside the home of the
beneficiary;
``(iii) providing written and verbal
beneficiary and caregiver education regarding
oxygen and oxygen related equipment, supplies,
and services, stationary and portable options,
and oxygen safety, which includes evaluating
the environment of the beneficiary for safety
risks or hazards, such as fire and fall
hazards;
``(iv) providing appropriate delivery, set-
up, and coordination of oxygen services
(including the delivery of any oxygen equipment
or supplies to a beneficiary prior to such
beneficiary being discharged, delivering such
equipment, and setting up the equipment), as
needed, in a timely manner as agreed upon by
the beneficiary or caregiver, supplier, and
prescribing practitioner;
``(v) evaluating the ability of the
beneficiary to operate the equipment safely and
effectively;
``(vi) providing infection control
information and instructions about all
equipment and supplies;
``(vii) providing equipment-related
services, including checking oxygen system
purity levels and flow rates, changing and
cleaning filters, and assuring the integrity of
alarms and back-up systems, consistent with the
manufacturer specifications and in accordance
with all Federal, State, and local laws and
regulations;
``(viii) monitoring visits when necessary
by appropriate personnel, including a
respiratory therapist to evaluate all aspects
of the services being provided to the
beneficiary by the provider;
``(ix) 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
care;
``(x) providing, as needed, continued
education to the beneficiary or caregiver
regarding appropriate oxygen equipment
maintenance practices and performance;
``(xi) providing, as prescribed by the plan
of care of the prescribing practitioner,
appropriate oxygen and oxygen related
equipment, supplies, and services (including
supplemental supplies and emergency oxygen
back-ups as appropriate);
``(xii) ensuring oxygen and oxygen
equipment can be used appropriately outside the
home of a beneficiary based on necessity;
``(xiii) providing 24-hour on-call coverage
to respond to beneficiary needs relating to
oxygen and oxygen related equipment, supplies,
and services; and
``(xiv) assisting the beneficiary with the
coordination of oxygen and oxygen related
equipment, supplies, and services, including by
assisting the beneficiary to find a different
supplier if the beneficiary temporarily travels
outside of the service area of the supplier. If
the beneficiary relocates permanently, the new
supplier caring for the beneficiary will assume
responsibility for billing the Medicare program
directly.''.
(b) Effective Date.--The amendment made by this section shall take
effect on the date that is 1 year after the date of enactment of this
Act.
SEC. 103. TECHNICAL CORRECTIONS.
Section 1861(n) is amended by striking ``iron lungs, oxygen tents''
and inserting ``oxygen and oxygen related equipment, supplies, and
services''.
TITLE II--PROTECTING BENEFICIARY ACCESS TO RESPIRATORY THERAPISTS
SEC. 201. REIMBURSEMENT FOR RESPIRATORY THERAPISTS.
(a) Protecting Access to Respiratory Therapist Services.--
(1) Adding respiratory therapist services to the definition
of medical and other health services.--Section 1861(s)(2) of
the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (JJ), by inserting ``and''
after the semicolon; and
(B) by adding at the end the following new
subparagraph:
``(KK) respiratory therapist services (as defined
in subsection (nnn)) furnished on or after January 1,
2026.''.
(2) Definition of respiratory therapist services.--Section
1861 of the Social Security Act (42 U.S.C. 1395x) is amended by
adding at the end the following new subsection:
``(nnn) 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 law, regulations, and applicable accreditation standards for the
assessment, treatment, and monitoring of patients requiring oxygen and
oxygen related equipment, supplies, or services.''.
(b) Add-On Payment Adjustment.--Section 1834(a)(9) of the Social
Security Act (42 U.S.C. 1395m(a)(9)), as amended by sections 101(b) and
102(a), is further amended by adding at the end the following new
subparagraph:
``(H) Monthly payment add-on adjustment for
respiratory therapist services.--For respiratory
therapist services furnished on or after January 1,
2026, 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 law.''.
TITLE III--ADOPTION OF ELECTRONIC TEMPLATES TO STRENGTHEN FRAUD AND
ABUSE PROTECTIONS AND ENSURE PROGRAM INTEGRITY
SEC. 301. STRENGTHENING PROGRAM INTEGRITY THROUGH THE USE OF ELECTRONIC
TEMPLATES TO DOCUMENT MEDICAL NECESSITY, AND RESTORING
CLINICAL INFERENCE FOR OXYGEN AND OXYGEN RELATED
EQUIPMENT, SUPPLIES, AND SERVICES.
(a) Adopting Electronic Templates for Determining Medical
Necessity.--Section 1834(a)(5) of the Social Security Act (42 U.S.C.
1395m(a)(5)) is amended by adding at the end the following:
``(G) Adoption of electronic templates to document
medical necessity and strengthen program integrity.--
``(i) In general.--For any oxygen and
oxygen related equipment, supplies, or service,
including liquid oxygen, furnished on or after
January 1, 2026, the Secretary shall adopt a
template in an electronic format that meets the
requirements of clause (ii) to be completed by
the prescribing practitioner (as defined by the
Secretary) that shall constitute the complete
request for information to determine whether
payment for such service, equipment, or
supplies is covered by this title and is
reasonable and necessary for the diagnosis or
treatment of illness or injury (under section
1862(a)(1)(A)).
``(ii) Template requirements.--The template
shall require the prescribing practitioner to
provide each of the following:
``(I) Documentation that the
beneficiary was seen by a prescribing
practitioner within the appropriate
timeframes for certification of the
need for the services, equipment, or
supplies.
``(II) Documentation of the
qualifying blood gas or saturation test
results.
``(III) Documentation indicating
that the beneficiary needs or is using
the appropriate equipment, supplies,
and services.
``(IV) Any other documentation
determined appropriate by the
Secretary, except the Secretary shall
not require the prescribing
practitioner to provide medical record
notes regarding the beneficiary.
``(iii) Contractor adjudication.--The
Secretary shall require Medicare administrative
contractors to adjudicate claims for payment
for oxygen and oxygen related equipment,
supplies, and services using electronic
transactions.
``(H) 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 equipment, supplies, and services under
this part the Secretary shall use clinical inference
and clinical judgment in the evaluation of templates,
medical records, and orders when conducting such audits
in the same manner as the Secretary interpreted and
applied such clinical judgment to claim reviews before
2009 pursuant to the Secretary's instruction to
contractors.''.
SEC. 302. ESTABLISHING NOTICE REQUIREMENTS FOR INDIVIDUALS RECEIVING
OXYGEN OR OXYGEN RELATED EQUIPMENT, SUPPLIES, OR
SERVICES.
(a) Annual Notice of Cost-Sharing Obligations for Supplemental
Oxygen.--Section 1804 of the Social Security Act (42 U.S.C. 1395b-2) is
amended by adding at the end the following new subsection:
``(e) The notice provided under subsection (a) shall include--
``(1) a description of--
``(A) the 36-month rental period for supplemental
oxygen equipment under section 1834(a)(5)(F);
``(B) the right of a beneficiary to discuss their
prescription for supplemental oxygen equipment with
their prescribing physician or practitioner; and
``(C) any cost sharing requirements for
supplemental oxygen equipment, supplies, and services
under this title and the termination of such
requirements when a beneficiary refuses or discontinues
supplemental oxygen therapy; and
``(2) information on the internal and external grievance
processes of suppliers of oxygen and oxygen related equipment,
supplies, and services under this title (as well as how to
contact Medicare through a hotline or beneficiary ombudsman),
including the right of a beneficiary to file, personally or
through a representative of the beneficiary's choosing, an
internal or external grievance without retaliation or denial of
services from a supplier.''.
(b) Timely Notice of End of Cost-Sharing Obligations for
Supplemental Oxygen.--Section 1834(a)(5)(F) of the Social Security Act
(42 U.S.C. 1395m(a)(5)(F)), is amended by adding at the end the
following new clause:
``(iii) Timely notice of end of cost-
sharing obligations for supplemental oxygen.--
The Secretary, in consultation with patient
advocates, physicians, supplemental oxygen
suppliers, respiratory therapists, and other
stakeholders, shall distribute a monthly notice
to each individual receiving supplemental
oxygen equipment, supplies, and services
stating the number of months remaining within
the rental cap period under this subparagraph
during which the beneficiary is responsible for
the copayment amount for such equipment.''.
TITLE IV--ESTABLISHMENT OF BENEFICIARY RIGHTS
SEC. 401. ESTABLISHING PROTECTIONS FOR INDIVIDUALS RECEIVING OXYGEN OR
OXYGEN RELATED EQUIPMENT, SUPPLIES, OR SERVICES.
Section 1834(a)(5) of the Social Security Act (42 U.S.C.
1395m(a)(5)), as amended by section 301, is further amended by adding
at the end the following new subparagraph:
``(H) Establishing protections for individuals
receiving oxygen or oxygen related equipment, supplies,
or services.--The Secretary shall establish through
regulation protections for any individual receiving
oxygen or oxygen related equipment, supplies, or
services under this part where such individual shall
have the right to--
``(i) choose the local supplier of such
services from among qualified suppliers and to
change such supplier;
``(ii) receive communications from the
supplier in a clear and understandable manner;
``(iii) ensure privacy and confidentiality
in all aspects of treatment and the personal
health information of such individual
consistent with Federal and State laws;
``(iv) be informed by the supplier of such
services regarding--
``(I) all aspects of the services
being furnished by such supplier;
``(II) the right to refuse
treatment and to discontinue treatment,
including informing the individual's
physician and indicating when
individual cost-sharing requirements
end; and
``(III) the right to refuse to
participate in experimental research;
``(v) be informed by the supplier of
policies and expectations of the supplier
regarding patient conduct and responsibilities;
``(vi) 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 supplier;
``(vii) be informed by the supplier of the
policies of such supplier regarding 24-hour on-
call coverage;
``(viii) be informed by the supplier of the
financial responsibilities of the individual
with regard to such services, including the
number of months remaining within the rental
cap period under subparagraph (F) during which
the patient is responsible for the copayment
amount;
``(ix) be provided with the appropriate
gaseous or liquid oxygen equipment, supplies,
and services to ensure the mobility of the
beneficiary, as well as the clinically
appropriate amount of oxygen and oxygen related
equipment, supplies, and services as agreed
upon by the individual (or the individual's
representative), the supplier, and the
prescribing practitioner;
``(x) receive equipment that is maintained
to the guidelines of the manufacturer;
``(xi) have broken or faulty equipment
repaired or replaced in a timely manner;
``(xii) have oxygen or oxygen related
equipment or supplies delivered by the supplier
and to be contacted consistent with the
requirements of section 410.38 of title 42,
Code of Federal Regulations;
``(xiii) in the case of a supplier
involuntary discharging an individual--
``(I) receive from such supplier a
written notice that is provided to the
individual no later than 30 days in
advance of the involuntary discharge of
the individual; and
``(II) have such supplier--
``(aa) follow established
involuntary discharge
procedures; or
``(bb) in the case of an
immediate threat to the health
and safety of others, follow an
abbreviated involuntary
discharge procedure;
``(xiv) be assisted by the supplier in
obtaining the oxygen equipment and supplies
prescribed by the treating physician of the
individual when the individual is traveling;
``(xv) receive from the supplier oxygen
supplies, refills, and emergency back-up
equipment, as appropriate;
``(xvi) be informed of a plan by the
supplier in case of a power outage or other
natural emergency, so that the individual will
continue to receive the necessary oxygen
supplies and equipment; and
``(xvii) be informed by the supplier of--
``(I) any potential changes to the
equipment, supplies, or services being
furnished to the individual and the
right to consult with the prescribing
physician or practitioner regarding
such changes to ensure they are
appropriate and necessary and to be
informed of the exceptions, as
specified by the Secretary, when a
supplemental oxygen services supplier
may change the oxygen equipment of the
individual; and
``(II) the internal and external
grievance processes of the supplier (as
well as how to contact Medicare through
a hotline or beneficiary ombudsman),
which shall include the right of an
individual to file, personally or
through a representative of the
individual's choosing, an internal or
external grievance without retaliation
or denial of services from such
supplier.''.
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