Patient Access to Durable Medical Equipment Act of 2016

(Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act to delay by one year the full implementation of new Medicare payment rates for durable medical equipment (such as wheelchairs).

(Sec. 3) In addition, the bill specifies that the bid ceiling for durable medical equipment items under Medicare's competitive acquisition program (through which rates are set according to a bidding process rather than by an established fee schedule) shall not be less than the fee schedule amount that would otherwise be determined for those items.

(Sec. 4) Under current law, the Centers for Medicare & Medicaid Services (CMS) must use payment information from competitive acquisition programs to make payment adjustments for durable medical equipment items furnished in areas outside of such programs. Current law also allows, but does not require, CMS to make such adjustments with respect to certain orthotics (such as splints and braces) and parenteral and enteral nutrients, equipment, and supplies (such as feeding tubes). The bill requires CMS, in making these adjustments, to account for stakeholder input. In addition, CMS must account for a comparison of competitive acquisition areas and other areas with respect to the following factors:

• average travel distance and cost associated with furnishing items and services,
• barriers to access,
• average delivery time,
• average volume of items and services furnished by suppliers, and
• number of suppliers.

(Sec. 5) In four quarterly reports, CMS must publish on its website the results of the monitoring of health outcomes and Medicare beneficiaries' access to durable medical equipment.

(Sec. 6) The bill accelerates the applicability, from January 1, 2019, to October 1, 2018, of provisions of current law that limit federal Medicaid reimbursement to states for durable medical equipment to Medicare payment rates.

Patient Access to Durable Medical Equipment Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to establish a bid ceiling for durable medical equipment (such as wheelchairs) under Medicare's competitive acquisition program, through which rates are set according to a bidding process rather than by an established fee schedule. Specifically, the bid ceiling for such an item shall not be less than the fee schedule amount that would otherwise be determined.

Under current law, the Centers for Medicare & Medicaid Services (CMS) must use payment information from competitive acquisition programs to make payment adjustments for areas outside of such programs. The bill requires CMS, in making these adjustments, to account for stakeholder input. In addition, CMS must account for a comparison of competitive acquisition areas and other areas with respect to the following factors:

• average travel distance and cost associated with furnishing items and services,
• barriers to access,
• average delivery time,
• average volume of items and services furnished by suppliers, and
• number of suppliers.

In addition, CMS shall delay by 15 months the full implementation of new Medicare payment rates for durable medical equipment.

On a monthly basis, CMS must publish on its website the results of the monitoring of health outcomes and Medicare beneficiaries' access to durable medical equipment.

The bill accelerates the applicability, from January 1, 2019, to October 1, 2018, of provisions of current law that limit federal Medicaid reimbursement to states for durable medical equipment to Medicare payment rates.