Ventilator Bill Introduced in Senate

Posted on in HME Government Issues

By Bob Hoffman, vice president, Nationwide Respiratory

On July 14, Sens. Bill Cassidy (R-La.) and Chuck Grassley (R-Iowa) introduced S. 3195, the Beneficiary Respiratory Equipment Access and Transparency to Home Ventilator Care Act of 2016, or the BREATH Act of 2016.

The BREATH Act addresses two significant issues with medical ventilators: reimbursement and vague Medicare guidelines for qualifying coverage of ventilators.

The Cassidy/Grassley bill would:

  • Require the Secretary of Health and Human Services to develop and implement clear evidence-based medical necessity standards for defining when prescribing a ventilator is reasonable and necessary by January 1, 2017. 
  • Require the Medicare program to increase payments to providers of ventilators by 20 percent on January 1, 2017. However, if during 2017 the number of Medicare patients prescribed ventilators does not decrease by at least 20 percent (2017 over 2015), then Medicare payments for 2018 will decrease by the difference between 20 percent and the actual decrease. This approach assures budget neutrality.

Click here to view the bill.

On January 1, 2016, the Centers for Medicare and Medicaid Services (CMS) reduced Medicare payments for ventilators by 25 to 30 percent. This reduction in payment has been devastating to providers of ventilators who serve the sickest patients—the patients who truly need a ventilator.  

Passage of this bill will ensure Americans living with neuromuscular diseases, thoracic restrictive diseases, and chronic obstructive pulmonary disease and fragile pediatric patients will continue to receive critical ventilator products and services.

“This bill eliminates current vague language for appropriate ventilator usage,” said John Gallagher of VGM Government Relations, “and adds a 20 percent reimbursement, which is huge for providers.”

What can you do to support S. 3195, the BREATH Act?

Please reach out to your members of Congress, and ask them to support this critical legislation. The process is simple and can be done by visiting VGM’s DC Link website.

Thank you for your time, and please contact me with any questions at 319-274-8406 or [email protected]