PATIENT ACCESS TO DURABLE MEDICAL EQUIPMENT ACT OF 2016
(House of Representatives - July 05, 2016)

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[Congressional Record Volume 162, Number 107 (Tuesday, July 5, 2016)]
[Pages H4230-H4235]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        PATIENT ACCESS TO DURABLE MEDICAL EQUIPMENT ACT OF 2016

  Mr. PITTS. Mr. Speaker, I move to suspend the rules and pass the bill 
(H.R. 5210) to improve access to durable medical equipment for Medicare 
beneficiaries under the Medicare program, and for other purposes, as 
amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5210

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Patient Access to Durable 
     Medical Equipment Act of 2016'' or the ``PADME Act''.

     SEC. 2. INCREASING OVERSIGHT OF TERMINATION OF MEDICAID 
                   PROVIDERS.

       (a) Increased Oversight and Reporting.--
       (1) State reporting requirements.--Section 1902(kk) of the 
     Social Security Act (42 U.S.C. 1396a(kk)) is amended--
       (A) by redesignating paragraph (8) as paragraph (9); and

[[Page H4231]]

       (B) by inserting after paragraph (7) the following new 
     paragraph:
       ``(8) Provider terminations.--
       ``(A) In general.--Beginning on July 1, 2018, in the case 
     of a notification under subsection (a)(41) with respect to a 
     termination for a reason specified in section 455.101 of 
     title 42, Code of Federal Regulations (as in effect on 
     November 1, 2015) or for any other reason specified by the 
     Secretary, of the participation of a provider of services or 
     any other person under the State plan (or under a waiver of 
     the plan), the State, not later than 21 business days after 
     the effective date of such termination, submits to the 
     Secretary with respect to any such provider or person, as 
     appropriate--
       ``(i) the name of such provider or person;
       ``(ii) the provider type of such provider or person;
       ``(iii) the specialty of such provider's or person's 
     practice;
       ``(iv) the date of birth, Social Security number, national 
     provider identifier, Federal taxpayer identification number, 
     and the State license or certification number of such 
     provider or person;
       ``(v) the reason for the termination;
       ``(vi) a copy of the notice of termination sent to the 
     provider or person;
       ``(vii) the date on which such termination is effective, as 
     specified in the notice; and
       ``(viii) any other information required by the Secretary.
       ``(B) Effective date defined.--For purposes of this 
     paragraph, the term `effective date' means, with respect to a 
     termination described in subparagraph (A), the later of--
       ``(i) the date on which such termination is effective, as 
     specified in the notice of such termination; or
       ``(ii) the date on which all appeal rights applicable to 
     such termination have been exhausted or the timeline for any 
     such appeal has expired.''.
       (2) Contract requirement for managed care entities.--
     Section 1932(d) of the Social Security Act (42 U.S.C. 1396u-
     2(d)) is amended by adding at the end the following new 
     paragraph:
       ``(5) Contract requirement for managed care entities.--With 
     respect to any contract with a managed care entity under 
     section 1903(m) or 1905(t)(3) (as applicable), no later than 
     July 1, 2018, such contract shall include a provision that 
     providers of services or persons terminated (as described in 
     section 1902(kk)(8)) from participation under this title, 
     title XVIII, or title XXI be terminated from participating 
     under this title as a provider in any network of such entity 
     that serves individuals eligible to receive medical 
     assistance under this title.''.
       (3) Termination notification database.--Section 1902 of the 
     Social Security Act (42 U.S.C. 1396a) is amended by adding at 
     the end the following new subsection:
       ``(ll) Termination Notification Database.--In the case of a 
     provider of services or any other person whose participation 
     under this title, title XVIII, or title XXI is terminated (as 
     described in subsection (kk)(8)), the Secretary shall, not 
     later than 21 business days after the date on which the 
     Secretary terminates such participation under title XVIII or 
     is notified of such termination under subsection (a)(41) (as 
     applicable), review such termination and, if the Secretary 
     determines appropriate, include such termination in any 
     database or similar system developed pursuant to section 
     6401(b)(2) of the Patient Protection and Affordable Care Act 
     (42 U.S.C. 1395cc note; Public Law 111-148).''.
       (4) No federal funds for items and services furnished by 
     terminated providers.--Section 1903 of the Social Security 
     Act (42 U.S.C. 1396b) is amended--
       (A) in subsection (i)(2)--
       (i) in subparagraph (A), by striking the comma at the end 
     and inserting a semicolon;
       (ii) in subparagraph (B), by striking ``or'' at the end; 
     and
       (iii) by adding at the end the following new subparagraph:
       ``(D) beginning not later than July 1, 2018, under the plan 
     by any provider of services or person whose participation in 
     the State plan is terminated (as described in section 
     1902(kk)(8)) after the date that is 60 days after the date on 
     which such termination is included in the database or other 
     system under section 1902(ll); or''; and
       (B) in subsection (m), by inserting after paragraph (2) the 
     following new paragraph:
       ``(3) No payment shall be made under this title to a State 
     with respect to expenditures incurred by the State for 
     payment for services provided by a managed care entity (as 
     defined under section 1932(a)(1)) under the State plan under 
     this title (or under a waiver of the plan) unless the State--
       ``(A) beginning on July 1, 2018, has a contract with such 
     entity that complies with the requirement specified in 
     section 1932(d)(5); and
       ``(B) beginning on January 1, 2018, complies with the 
     requirement specified in section 1932(d)(6)(A).''.
       (5) Development of uniform terminology for reasons for 
     provider termination.--Not later than July 1, 2017, the 
     Secretary of Health and Human Services shall, in consultation 
     with the heads of State agencies administering State Medicaid 
     plans (or waivers of such plans), issue regulations 
     establishing uniform terminology to be used with respect to 
     specifying reasons under subparagraph (A)(v) of paragraph (8) 
     of section 1902(kk) of the Social Security Act (42 U.S.C. 
     1396a(kk)), as amended by paragraph (1), for the termination 
     (as described in such paragraph) of the participation of 
     certain providers in the Medicaid program under title XIX of 
     such Act or the Children's Health Insurance Program under 
     title XXI of such Act.
       (6) Conforming amendment.--Section 1902(a)(41) of the 
     Social Security Act (42 U.S.C. 1396a(a)(41)) is amended by 
     striking ``provide that whenever'' and inserting ``provide, 
     in accordance with subsection (kk)(8) (as applicable), that 
     whenever''.
       (b) Increasing Availability of Medicaid Provider 
     Information.--
       (1) FFS provider enrollment.--Section 1902(a) of the Social 
     Security Act (42 U.S.C. 1396a(a)) is amended by inserting 
     after paragraph (77) the following new paragraph:
       ``(78) provide that, not later than January 1, 2017, in the 
     case of a State plan (or a waiver of the plan) that provides 
     medical assistance on a fee-for-service basis, the State 
     shall require each provider furnishing items and services to 
     individuals eligible to receive medical assistance under such 
     plan to enroll with the State agency and provide to the State 
     agency the provider's identifying information, including the 
     name, specialty, date of birth, Social Security number, 
     national provider identifier, Federal taxpayer identification 
     number, and the State license or certification number of the 
     provider;''.
       (2) Managed care provider enrollment.--Section 1932(d) of 
     the Social Security Act (42 U.S.C. 1396u-2(d)), as amended by 
     subsection (a)(2), is amended by adding at the end the 
     following new paragraph:
       ``(6) Enrollment of participating providers.--
       ``(A) In general.--Beginning not later than January 1, 
     2018, a State shall require that, in order to participate as 
     a provider in the network of a managed care entity that 
     provides services to, or orders, prescribes, refers, or 
     certifies eligibility for services for, individuals who are 
     eligible for medical assistance under the State plan under 
     this title (or under a waiver of the plan) and who are 
     enrolled with the entity, the provider is enrolled with the 
     State agency administering the State plan under this title 
     (or waiver of the plan). Such enrollment shall include 
     providing to the State agency the provider's identifying 
     information, including the name, specialty, date of birth, 
     Social Security number, national provider identifier, Federal 
     taxpayer identification number, and the State license or 
     certification number of the provider.
       ``(B) Rule of construction.--Nothing in subparagraph (A) 
     shall be construed as requiring a provider described in such 
     subparagraph to provide services to individuals who are not 
     enrolled with a managed care entity under this title.''.
       (c) Coordination With CHIP.--
       (1) In general.--Section 2107(e)(1) of the Social Security 
     Act (42 U.S.C. 1397gg(e)(1)) is amended--
       (A) by redesignating subparagraphs (B), (C), (D), (E), (F), 
     (G), (H), (I), (J), (K), (L), (M), (N), and (O) as 
     subparagraphs (D), (E), (F), (G), (H), (I), (J), (K), (M), 
     (N), (O), (P), (Q), and (R), respectively;
       (B) by inserting after subparagraph (A) the following new 
     subparagraphs:
       ``(B) Section 1902(a)(39) (relating to termination of 
     participation of certain providers).
       ``(C) Section 1902(a)(78) (relating to enrollment of 
     providers participating in State plans providing medical 
     assistance on a fee-for-service basis).'';
       (C) by inserting after subparagraph (K) (as redesignated by 
     subparagraph (A)) the following new subparagraph:
       ``(L) Section 1903(m)(3) (relating to limitation on payment 
     with respect to managed care).''; and
       (D) in subparagraph (P) (as redesignated by subparagraph 
     (A)), by striking ``(a)(2)(C) and (h)'' and inserting 
     ``(a)(2)(C) (relating to Indian enrollment), (d)(5) (relating 
     to contract requirement for managed care entities), (d)(6) 
     (relating to enrollment of providers participating with a 
     managed care entity), and (h) (relating to special rules with 
     respect to Indian enrollees, Indian health care providers, 
     and Indian managed care entities)''.
       (2) Excluding from medicaid providers excluded from chip.--
     Section 1902(a)(39) of the Social Security Act (42 U.S.C. 
     1396a(a)(39)) is amended by striking ``title XVIII or any 
     other State plan under this title'' and inserting ``title 
     XVIII, any other State plan under this title (or waiver of 
     the plan), or any State child health plan under title XXI (or 
     waiver of the plan)''.
       (d) Rule of Construction.--Nothing in this section shall be 
     construed as changing or limiting the appeal rights of 
     providers or the process for appeals of States under the 
     Social Security Act.
       (e) OIG Report.--Not later than March 31, 2020, the 
     Inspector General of the Department of Health and Human 
     Services shall submit to Congress a report on the 
     implementation of the amendments made by this section. Such 
     report shall include the following:
       (1) An assessment of the extent to which providers who are 
     included under subsection (ll) of section 1902 of the Social 
     Security Act (42 U.S.C. 1396a) (as added by subsection 
     (a)(3)) in the database or similar system referred to in such 
     subsection are terminated (as described in subsection (kk)(8) 
     of such section, as added by subsection (a)(1)) from 
     participation in all State plans under title XIX of such Act 
     (or waivers of such plans).
       (2) Information on the amount of Federal financial 
     participation paid to States under section 1903 of such Act 
     in violation of the

[[Page H4232]]

     limitation on such payment specified in subsections (i)(2)(D) 
     and (m)(3) of such section, as added by subsection (a)(4) of 
     this section.
       (3) An assessment of the extent to which contracts with 
     managed care entities under title XIX of such Act comply with 
     the requirement specified in section 1932(d)(5) of such Act, 
     as added by subsection (a)(2) of this section.
       (4) An assessment of the extent to which providers have 
     been enrolled under section 1902(a)(78) or 1932(d)(6)(A) of 
     such Act (42 U.S.C. 1396a(a)(78), 1396u-2(d)(6)(A)) with 
     State agencies administering State plans under title XIX of 
     such Act (or waivers of such plans).

     SEC. 3. REQUIRING PUBLICATION OF FEE-FOR-SERVICE PROVIDER 
                   DIRECTORY.

       (a) In General.--Section 1902(a) of the Social Security Act 
     (42 U.S.C. 1396a(a)) is amended--
       (1) in paragraph (80), by striking ``and'' at the end;
       (2) in paragraph (81), by striking the period at the end 
     and inserting ``; and''; and
       (3) by inserting after paragraph (81) the following new 
     paragraph:
       ``(82) provide that, not later than January 1, 2017, in the 
     case of a State plan (or waiver of the plan) that provides 
     medical assistance on a fee-for-service basis or through a 
     primary care case-management system described in section 
     1915(b)(1) (other than a primary care case management entity 
     (as defined by the Secretary)), the State shall publish (and 
     update on at least an annual basis) on the public Website of 
     the State agency administering the State plan, a directory of 
     the physicians described in subsection (mm) and, at State 
     option, other providers described in such subsection that--
       ``(A) includes--
       ``(i) with respect to each such physician or provider--

       ``(I) the name of the physician or provider;
       ``(II) the specialty of the physician or provider;
       ``(III) the address at which the physician or provider 
     provides services; and
       ``(IV) the telephone number of the physician or provider; 
     and

       ``(ii) with respect to any such physician or provider 
     participating in such a primary care case-management system, 
     information regarding--

       ``(I) whether the physician or provider is accepting as new 
     patients individuals who receive medical assistance under 
     this title; and
       ``(II) the physician's or provider's cultural and 
     linguistic capabilities, including the languages spoken by 
     the physician or provider or by the skilled medical 
     interpreter providing interpretation services at the 
     physician's or provider's office; and

       ``(B) may include, at State option, with respect to each 
     such physician or provider--
       ``(i) the Internet website of such physician or provider; 
     or
       ``(ii) whether the physician or provider is accepting as 
     new patients individuals who receive medical assistance under 
     this title.''.
       (b) Directory Physician or Provider Described.--Section 
     1902 of the Social Security Act (42 U.S.C. 1396a), as amended 
     by section 2(a)(3), is further amended by adding at the end 
     the following new subsection:
       ``(mm) Directory Physician or Provider Described.--A 
     physician or provider described in this subsection is--
       ``(1) in the case of a physician or provider of a provider 
     type for which the State agency, as a condition on receiving 
     payment for items and services furnished by the physician or 
     provider to individuals eligible to receive medical 
     assistance under the State plan, requires the enrollment of 
     the physician or provider with the State agency, a physician 
     or a provider that--
       ``(A) is enrolled with the agency as of the date on which 
     the directory is published or updated (as applicable) under 
     subsection (a)(82); and
       ``(B) received payment under the State plan in the 12-month 
     period preceding such date; and
       ``(2) in the case of a physician or provider of a provider 
     type for which the State agency does not require such 
     enrollment, a physician or provider that received payment 
     under the State plan (or waiver of the plan) in the 12-month 
     period preceding the date on which the directory is published 
     or updated (as applicable) under subsection (a)(82).''.
       (c) Rule of Construction.--
       (1) In general.--The amendment made by subsection (a) shall 
     not be construed to apply in the case of a State (as defined 
     for purposes of title XIX of the Social Security Act) in 
     which all the individuals enrolled in the State plan under 
     such title (or under a waiver of such plan), other than 
     individuals described in paragraph (2), are enrolled with a 
     medicaid managed care organization (as defined in section 
     1903(m)(1)(A) of such Act (42 U.S.C. 1396b(m)(1)(A))), 
     including prepaid inpatient health plans and prepaid 
     ambulatory health plans (as defined by the Secretary of 
     Health and Human Services).
       (2) Individuals described.--An individual described in this 
     paragraph is an individual who is an Indian (as defined in 
     section 4 of the Indian Health Care Improvement Act (25 
     U.S.C. 1603)) or an Alaska Native.
       (d) Exception for State Legislation.--In the case of a 
     State plan under title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.), which the Secretary of Health and Human 
     Services determines requires State legislation in order for 
     the respective plan to meet one or more additional 
     requirements imposed by amendments made by this section, the 
     respective plan shall not be regarded as failing to comply 
     with the requirements of such title solely on the basis of 
     its failure to meet such an additional requirement before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of the 
     session shall be considered to be a separate regular session 
     of the State legislature.

     SEC. 4. EXTENSION OF THE TRANSITION TO NEW PAYMENT RATES FOR 
                   DURABLE MEDICAL EQUIPMENT UNDER THE MEDICARE 
                   PROGRAM.

       (a) In General.--The Secretary of Health and Human Services 
     shall extend the transition period described in clause (i) of 
     section 414.210(g)(9) of title 42, Code of Federal 
     Regulations, from June 30, 2016, to September 30, 2016 (with 
     the full implementation described in clause (ii) of such 
     section applying to items and services furnished with dates 
     of service on or after October 1, 2016).
       (b) Study and Report.--
       (1) Study.--
       (A) In general.--The Secretary of Health and Human Services 
     shall conduct a study that examines the impact of applicable 
     payment adjustments upon--
       (i) the number of suppliers of durable medical equipment 
     that, on a date that is not before January 1, 2016, and not 
     later than September 1, 2016, ceased to conduct business as 
     such suppliers; and
       (ii) the availability of durable medical equipment, during 
     the period beginning on January 1, 2016, and ending on 
     September 1, 2016, to individuals entitled to benefits under 
     part A of title XVIII of the Social Security Act (42 U.S.C. 
     1395 et seq.) or enrolled under part B of such title.
       (B) Definitions.--For purposes of this subsection, the 
     following definitions apply:
       (i) Supplier; durable medical equipment.--The terms 
     ``supplier'' and ``durable medical equipment'' have the 
     meanings given such terms by section 1861 of the Social 
     Security Act (42 U.S.C. 1395x).
       (ii) Applicable payment adjustment.--The term ``applicable 
     payment adjustment'' means a payment adjustment described in 
     section 414.210(g) of title 42, Code of Federal Regulations, 
     that is phased in by paragraph (9)(i) of such section. For 
     purposes of the preceding sentence, a payment adjustment that 
     is phased in pursuant to the extension under subsection (a) 
     shall be considered a payment adjustment that is phased in by 
     such paragraph (9)(i).
       (2) Report.--The Secretary of Health and Human Services 
     shall, not later than September 10, 2016, submit to the 
     Committees on Ways and Means and on Energy and Commerce of 
     the House of Representatives, and to the Committee on Finance 
     of the Senate, a report on the findings of the study 
     conducted under paragraph (1).

     SEC. 5. EXCLUSION OF PAYMENTS FROM STATE EUGENICS 
                   COMPENSATION PROGRAMS FROM CONSIDERATION IN 
                   DETERMINING ELIGIBILITY FOR, OR THE AMOUNT OF, 
                   FEDERAL PUBLIC BENEFITS.

       (a) In General.--Notwithstanding any other provision of 
     law, payments made under a State eugenics compensation 
     program shall not be considered as income or resources in 
     determining eligibility for, or the amount of, any Federal 
     public benefit.
       (b) Definitions.--For purposes of this section:
       (1) Federal public benefit.--The term ``Federal public 
     benefit'' means--
       (A) any grant, contract, loan, professional license, or 
     commercial license provided by an agency of the United States 
     or by appropriated funds of the United States; and
       (B) any retirement, welfare, health, disability, public or 
     assisted housing, postsecondary education, food assistance, 
     unemployment benefit, or any other similar benefit for which 
     payments or assistance are provided to an individual, 
     household, or family eligibility unit by an agency of the 
     United States or by appropriated funds of the United States.
       (2) State eugenics compensation program.--The term ``State 
     eugenics compensation program'' means a program established 
     by State law that is intended to compensate individuals who 
     were sterilized under the authority of the State.

     SEC. 6. DEPOSIT OF SAVINGS INTO MEDICARE IMPROVEMENT FUND.

       Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
     1395iii(b)(1)) is amended by striking ``$0'' and inserting 
     ``$3,000,000''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Pennsylvania (Mr. Pitts) and the gentleman from Vermont (Mr. Welch) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Pennsylvania.


                             General Leave

  Mr. PITTS. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous materials in the Record on the bill, including an 
exchange of letters between the Committee on Energy and Commerce and 
the Committee on Ways and Means.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Pennsylvania?

[[Page H4233]]

  There was no objection.
  Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the bipartisan bill before us accomplishes several 
important objectives. Since 2003, the durable medical equipment, DME, 
competitive bidding program has required DME suppliers in certain 
large, densely populated areas to compete for contracts to serve 
Medicare beneficiaries in those areas. This market-based competition 
has saved the Medicare program and beneficiaries billions of dollars in 
saving and reduced cost sharing.
  Since 2009, CMS has had the authority to expand the program to 
additional areas, and in 2014 the agency published a final rule that 
will expand competitive bidding to all areas of the country. Beginning 
January 1, 2016, CMS began phasing in new regional reimbursement rates 
for noncompetitive bid areas using a 50-50 blend of old and new rates. 
Starting July 1, rates will be based on the new calculations.
  To ensure we have a full appreciation of the impact of the phase-in, 
the bill continues the 50-50 blend payment for an additional 3 months. 
It also requires HHS to report to Congress on any access issues caused 
by the blended rate before the full rate change can go into effect.
  The bill also improves access to quality healthcare providers for 
vulnerable Medicaid patients and includes legislation that recently 
passed the House 406-0.
  In this legislation, we again reiterate the House's support to 
address two important issues that plague Medicaid beneficiaries: first, 
State Medicaid programs too often suffer from waste, fraud, and abuse; 
and, second, too many Medicaid patients may have a hard time finding a 
doctor.
  The bill would ensure healthcare providers terminated from Medicare 
or one State's Medicaid program for reasons of fraud, integrity, or 
quality are also terminated from other State Medicaid programs. The 
Office of Inspector General at HHS has previously found that 12 percent 
of terminated providers were participating in a State Medicaid program 
after the same provider was terminated from another State Medicaid 
program. It is critical that fraudulent providers are not allowed to 
defraud taxpayers or harm patients across the board.
  The bill also requires State Medicaid programs to provide 
beneficiaries served under fee-for-service or primary care case 
management programs an electronic directory of physicians participating 
in the program. This important effort will address a critical challenge 
of Medicaid patients in accessing certain types of care, such as 
obtaining specialty care or dental care. Medicaid patients would now 
have better information by simply applying requirements similar to 
those in place for Medicaid-managed care plans to fee-for-service and/
or primary care case management programs.
  Finally, the bill includes legislation by Mr. McHenry and Mr. 
Butterfield that ensures that payments made under a State eugenics 
compensation program cannot be considered as income in determining 
eligibility for any Federal public benefit. Simply put, the bill 
prevents any funds from such a compensation program to be counted as 
income for purposes of receiving any Federal benefits.
  According to the Congressional Budget Office, H.R. 5210, as amended, 
would be completely offset over the budget window. We will provide more 
time to understand the impact of DME payment changes on Medicare 
beneficiaries. We will also enact commonsense reforms that help protect 
Medicaid beneficiaries, improve access to care, and enact an important 
clarification for those eligible for certain State compensation 
programs.
  I want to thank Ranking Member Pallone and his staff as well as the 
Committee on Ways and Means for their work on this compromise, and I 
urge my colleagues to support H.R. 5210, as amended.
  Mr. Speaker, I reserve the balance of my time.

                                         House of Representatives,


                                  Committee on Ways and Means,

                                    Washington, DC, June 21, 2016.
     The Hon. Fred Upton,
     Chairman, Committee on Energy and Commerce,
     Washington, DC.
       Dear Chairman Upton: I am writing concerning H.R. 5210, the 
     ``Patient Access to Durable Medical Equipment Act of 2016,'' 
     on which the Committee on Ways and Means was granted an 
     additional referral.
       In order to allow H.R. 5210 to move expeditiously to the 
     House floor, I agree to waive formal consideration of this 
     bill. The Committee on Ways and Means takes this action with 
     our mutual understanding that by foregoing consideration on 
     H.R. 5210 at this time, we do not waive any jurisdiction over 
     subject matter contained in this or similar legislation, and 
     that our Committee will be appropriately consulted and 
     involved as this bill or similar legislation moves forward. 
     Our Committee also reserves the right to seek appointment of 
     an appropriate number of conferees to any House-Senate 
     conference involving this or similar legislation, and asks 
     that you support any such request.
       I would appreciate your response to this letter confirming 
     this understanding, and would request that you include a copy 
     of this letter and your response in the Congressional Record 
     during the floor consideration of this bill. Thank you in 
     advance for your cooperation.
           Sincerely,
                                                      Kevin Brady,
     Chairman.
                                  ____

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                    Washington, DC, June 21, 2016.
     The Hon. Kevin Brady,
     Chairman, Committee on Ways and Means,
     Washington, DC.
       Dear Chairman Brady: Thank you for your letter regarding 
     H.R. 5210, the ``Patient Access to Durable Medical Equipment 
     Act of 2016,'' on which the Committee on Ways and Means was 
     granted an additional referral.
       I appreciate your agreeing to waive formal consideration of 
     H.R. 5210 in order to allow the bill to move expeditiously to 
     the House floor.
       I agree that by foregoing consideration on H.R. 5210 at 
     this time, the Committee on Ways and Means does not waive any 
     jurisdiction over subject matter contained in this or similar 
     legislation, and that the Committee will be appropriately 
     consulted and involved as this bill or similar legislation 
     moves forward. I also agree that the Committee reserves the 
     right to seek appointment of an appropriate number of 
     conferees to any House-Senate conference involving this or 
     similar legislation, and I will support any such request.
       Finally, I will include a copy of your letter and this 
     response in the Congressional Record during the floor 
     consideration of this bill.
           Sincerely,
                                                       Fred Upton,
                                                         Chairman.

  Mr. WELCH. Mr. Speaker, I yield myself such time as I may consume.
  I thank my colleague, Mr. Pitts. It is a pleasure to be working with 
him and with Mr. Pallone and Mr. Upton.
  This legislation, as Mr. Pitts indicated, is going to give some 
relief to communities, particularly rural communities, from the 
imposition of changes in how charges are made in competitive bidding 
processes that have a significant potential to make inaccessible 
durable medical equipment.
  I was a cosponsor, but the lead sponsor is here, Dr. Price, a good 
colleague and a really good doctor. Dr. Price, Legislator Price, came 
up with a pretty good bill that is going to help Georgia but also help 
rural Vermont, so I appreciate that.

                              {time}  1745

  The bottom line, the DME Competitive Bidding Program was created in 
2003. It was aimed at a goal all of us have. It was trying to lower 
spending on durable medical equipment. It was well-intended, but it has 
had some serious consequences, especially for rural providers, like in 
Vermont, and I am sure parts of Georgia and other rural parts of the 
country.
  By the way, when we do something, it can have a good intention, it 
can even accomplish some of its goals, but I think it always makes 
sense for us on both sides to step back after there is some history--
this went in in 2003--and take a look, kick the tires. What are some of 
the improvements that we can make so that we get back to the original 
intention and don't do harm that is unnecessary? And that is what the 
Price legislation is doing.
  In January 2016, the Competitive Bidding Program began its nationwide 
rollout. That was under the new CMS guidelines. As a result, the rural 
areas saw significant cuts. It really does jeopardize access to this 
important equipment for beneficiaries.
  The CMS continued its rollout in July with a second round of cuts. It 
further slashed reimbursement rates for DME across rural America, 
including Vermont.
  In Vermont, we have an excellent equipment provider, Yankee Medical, 
that is reasonable in its price and incredibly good in its service. It 
will

[[Page H4234]]

bring equipment to people all across rural Vermont. That is such a 
benefit for folks who can't get out of their homes.
  The rural areas do have different challenges than urban areas. It is 
much more challenging for stakeholders to absorb these cuts. For 
instance, a small business in rural Vermont in a noncompetitively bid 
area may not have a large amount of Medicare-related businesses and, 
therefore, might not be able to afford the prices that a business in a 
much larger populated area could offer.
  So this legislation is going to put on hold for 3 months what these 
prices will be. It is going to allow time for some adjustment and, 
hopefully, for us to consider other positive reforms that will be 
helpful to maintaining access to important healthcare equipment for 
folks in rural Vermont and rural America.
  The bill contains a couple of other provisions, one of which I will 
speak about. My colleague on the Energy and Commerce Committee, Mr. 
Bucshon, was the lead sponsor and I was his cosponsor. As a way to pay 
for this--and that was cracking down on this Medicare fraud, where 
there has been a failure administratively--when a provider is found to 
be fraudulent in one district, that fraud is not then communicated to 
all other districts or States, so that fraudulent provider tries to 
just take their operation elsewhere. This is going to require that 
notification and it is going to shut down that fraud much more quickly, 
saving money, and then helping us to pay for this.
  So this is practical legislation, the result of a compromise by the 
chairman and ranking member of the Energy and Commerce Committee, Mr. 
Pitts, and some of my colleagues. Mr. Loebsack of Iowa played a very, 
very active role in this legislation. Of course, Dr. Price did as well.
  Mr. Speaker, I yield back the balance of my time.
  Mr. PITTS. Mr. Speaker, I yield 3 minutes to the gentleman from 
Georgia (Mr. Price), the distinguished Budget Committee chairman.
  Mr. TOM PRICE of Georgia. Mr. Speaker, I want to thank the gentleman 
from Pennsylvania for his work on this and his interest and passion for 
healthcare issues and the work that we do in this House. I also want to 
thank the gentleman from Vermont for his kind words and the work he has 
done on this; and the gentleman from Iowa as well, who has been 
instrumental in moving this legislation forward.
  Mr. Speaker, many Medicare beneficiaries rely on a set of healthcare 
products and services that are classified as durable medical equipment, 
or DME. DME is often life-improving or lifesaving; things like blood 
sugar monitors, canes, crutches, hospital beds, power wheelchairs, and 
even things like oxygen supplies and tanks. Without access to these 
items, many Medicare beneficiaries would not be able to survive or 
would see their quality of life greatly diminished.
  In January 2016, Medicare started to slash reimbursement rates for 
these products and services as part of a nationwide rollout of their 
Competitive Bidding Program.
  Mr. Speaker, I would suggest that this program is neither competitive 
nor is it a real bidding process. CMS now wants to extend these 
substandard rates and this substandard program to other areas, as you 
have heard, including rural regions of our Nation, where these new 
rates will oftentimes not even cover the cost of the delivery of the 
item or the service, which means they just won't happen.
  In addition, this CMS program has failed to hold bidders to account. 
It has failed to produce rates that are financially sustainable for 
those who are trying to provide these service and items to patients.
  The National Minority Quality Forum has data that demonstrates this 
program is driving up costs through avoidable hospital bills and 
inpatient admissions, increasing out-of-pocket payments by patients, 
and has led to increased mortality rates. Mr. Speaker, that is more 
people dying in our Nation because of this program.
  In just my home State of Georgia, there has been a 20 percent 
decrease in the number of DME suppliers between 2013 and 2016. The 
number of medical equipment supply stores in our State has similarly 
decreased by nearly 40 percent.
  The legislation we have before us today, H.R. 5210, would provide a 
3-month delay in the cuts, hopefully allowing for work to be done to 
come up with a real solution.
  This legislation represents a bipartisan commitment to ensure that 
Medicare beneficiaries continue receiving critical care provided 
through durable medical equipment, particularly those living in the 
rural areas of our Nation who would be disproportionately harmed by 
cuts in reimbursements.
  Again, this delay will, hopefully, provide policymakers additional 
time to come up with a consensus on a long-term solution. Every effort 
must be made to protect access to quality health care for seniors.
  I want to thank, again, my colleagues on both sides of the aisle for 
their work on this issue. I want to, once again, commend Chairman Pitts 
for his work on this issue.
  I urge adoption of the bill.
  Mr. PITTS. Mr. Speaker, I urge support for this bipartisan bill, H.R. 
5210.
  I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I cannot support a delay in the expansion 
of the competitive bidding program. Competitive bidding for durable 
medical equipment, prosthetics, orthotics, and supplies (DMEPOS) has 
saved the Medicare program billions of dollars. And lowering costs for 
the Medicare program means lower copayments for Medicare beneficiaries.
  Over the years, it has been widely documented by the HHS Office of 
Inspector General and the Government Accountability Office that 
Medicare payments for DMEPOS far exceeded reasonable costs. This is why 
Congress passed legislation requiring competitive bidding for DMEPOS 
incrementally. Since 2011, CMS has closely monitored all beneficiaries 
in the competitive bidding areas, and there have been no access 
concerns. Health outcomes are steady compared to before Medicare began 
the competitive bidding program. CMS will continue to monitor health 
outcomes, and until we see any concerns, I do not believe we should 
stop the progress in saving money for both beneficiaries and the 
Medicare program.
  That said, the Medicaid policies in this legislation were passed by 
the House in March of this year, 406-0, after consideration by the 
House Energy and Commerce Committee. The first policy, the Medicaid DOC 
Act, is an initiative first introduced by Reps. Collins and Tonko and 
would require states that participate in fee-for-service Medicaid to 
publish electronic provider directories. It's important for patients to 
know what providers participate in the Medicaid program. States are 
required to provide electronic directories in managed care, but the 
same requirement does not exist across the full Medicaid program. The 
Committee worked throughout the legislative process to streamline this 
policy with current federal provider directory regulations in Medicaid 
managed care. The legislation details the minimum items that must be 
included in a provider directory, but also allows states to go beyond 
these standards.
  The second policy is an initiative first introduced by Reps. Bucshon, 
Welch, and Butterfield and would provide CMS with critical tools to 
keep patients safe, protect taxpayer dollars, and protect the integrity 
of the Medicaid program. The ACA included a provision that prohibited 
disqualified providers from Medicare or one state Medicaid program from 
simply crossing state lines and receiving payments in another state 
Medicaid program. Unfortunately, as drafted, the law has been hard to 
implement, because states don't have a consistent or standardized way 
of knowing when a specific provider has been terminated by Medicare or 
another state. States are not currently required to report this 
information, and if it is reported, it is in many differing formats, 
limiting the data's usability. This provision would require all states 
to report information on fraudulent providers to the Secretary for 
inclusion in a currently existing termination database that is 
accessible to all states. The legislation also requires the Secretary 
to develop uniform criteria for states to use when submitting 
information. I supported both of these commonsense policies in the 
past, and I continue to support them today.
  Mr. McDERMOTT. Mr. Speaker, this bill, H.R. 5210, the Patient Access 
to Durable Medical Equipment Act, delays the implementation of recent 
changes to durable medical equipment payments.
  For the past several years, Medicare has been reforming how we pay 
for DME, including items like oxygen tanks, walkers, or hospital beds.
  In much of the country, CMS uses competitive bidding to determine how 
much DME costs. But in some communities, primarily in rural areas, CMS 
pays under the DME fee

[[Page H4235]]

schedule. Under this payment system, there is no competitive market to 
drive prices down.
   Nonpartisan, independent experts, including MedPAC and the 
Government Accountability Office, have warned us that Medicare is 
overpaying for DME through the fee schedule.
  To address this problem, CMS has been phasing in new payments that 
will reduce DME costs under the fee schedule based on competitive 
bidding pricing. These lower payments are scheduled to be fully phased 
in by July.
  Getting DME costs under control is critical. Higher prices result in 
increased Medicare spending and, even more importantly, they force 
beneficiaries to pay more out of pocket.
  At the same time, some DME suppliers and beneficiary groups have 
expressed concerns that lowering the price for DME too far could hinder 
beneficiary access to important equipment.
  To address this issue, the bill before us provides a compromise that 
will institute a temporary delay of the lower DME fee schedule payments 
for three months. This pause will allow us to gather more data on how 
the new payment rates impact beneficiary access.
  That being said, it's not entirely clear that this delay is 
necessary. CMS has already been carefully monitoring access to DME. 
Just this month, the agency released data showing that payment cuts 
have not caused any harm to suppliers or to beneficiaries.
  Even as we have significantly reduced spending, suppliers continue to 
accept the reformed payment rates, and there is no evidence that 
beneficiary access to high quality DME has been hindered.
  This bill will give us three more months to verify that this is the 
case. This is only a short-term freeze, and if the evidence continues 
to show that the new payment rates are working, there will be no reason 
for us to delay any longer.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Pennsylvania (Mr. Pitts) that the House suspend the 
rules and pass the bill, H.R. 5210, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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