S. 2736 — what changed

changed 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 June 30, 2017 (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 July 1, 2017).

Section 1847(b)(5) of the Social Security Act (42 U.S.C. 1395w–3(b)(5)) is amended—

changed “(E) Bid Floor on bid ceiling for durable medical equipment

changed “(i) In general—The ceiling for a bid submitted for applicable covered items may not be less than the fee schedule amount that would otherwise be determined for such items under section 1834(a), section 1834(h), or section 1842(s)(1) on January 1, 2015, updated by the covered item update 1842(s) for such items under section 1834(a)(14)(L), section 1834(h), or section 1842(s)(1), respectively, furnished on July 1, 2016 (determined as appropriate for if section 2 of the year with respect Patient Access to which the bid ceiling is established for such applicable covered item.Durable Medical Equipment Act of 2016 had not been enacted).

changed “(ii) Application to new Applicable covered items—The Secretary shall establish a process for items defined—For purposes of applying clause (i) this subparagraph, the term “applicable covered items” means competitively priced items and services described in subsection (a)(2) that are furnished with respect to applicable covered items for which no fee schedule amount would otherwise be paid under section 1834(a), section 1834(h), or section 1842(s), as appropriate, rounds of competition that begin on or after January 1, 2015.2017.”

removed “(iii) Applicable covered items defined—For purposes of this subparagraph, the term “applicable covered items” means competitively priced items and services described in subsection (a)(2) that are furnished with respect to rounds of competition that begin on or after January 1, 2017.”

added “(i) solicit and take into account stakeholder input; and

added “(ii) take into account the highest amount bid by a winning supplier in a competitive acquisition area and a comparison of each of the following with respect to non-competitive acquisition areas and competitive acquisition areas:

added “(I) The average travel distance and cost associated with furnishing items and services in the area.

added “(II) Any barriers to access for items and services in the area.

added “(III) The average delivery time in furnishing items and services in the area.

added “(IV) The average volume of items and services furnished by suppliers in the area.

added “(V) The number of suppliers in the area.”

removed Section 1834(a)(1)(G) of the Social Security Act (42 U.S.C. 1395m(a)(1)(G)) is amended by adding at the end the following new sentence: “In the case of items and services furnished on or after January 1, 2019, in making any adjustments under clause (ii) or (iii) of subparagraph (F), the Secretary shall—

removed “(i) solicit and take into account stakeholder input; and

removed “(ii) take into account the highest amount bid by a winning supplier in a competitive acquisition area and a comparison of each of the following with respect non-competitive acquisition areas and competitive acquisition areas:

removed “(I) The average travel distance and cost associated with furnishing items and services in the area.

removed “(II) Any barriers to access for items and services in the area.

removed “(III) The average delivery time in furnishing items and services in the area.

removed “(IV) The average volume of items and services furnished by suppliers in the area.

removed “(V) The number of suppliers in the area.”

changed Not later than the first of each month (beginning with May October 1, 2016, January 1, 2017, April 1, 2017, and ending with September July 1, 2017), 2017, the Secretary of Health and Human Services shall publish on the Internet website of the Centers for Medicare & Medicaid Services the results of the monitoring of access of Medicare beneficiaries to durable medical equipment and of health outcomes, as described on page 66228 in the final rule published by the Center for Medicare & Medicaid Services on November 6, 2014, and entitled “Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies” (79 Fed. Reg. 66120–66265).