Sec. 504. TREATMENT OF DISPOSABLE DEVICES
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## SEC. 504 TREATMENT OF DISPOSABLE DEVICES ###
(a)In general Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: > > ### “(s) Payment for Applicable Disposable Devices > > > #### “(1) Separate payment > > The Secretary shall make a payment (separate from the payments otherwise made under section 1895) in the amount established under paragraph
(3)to a home health agency for an applicable disposable device (as defined in paragraph (2)) when furnished on or after January 1, 2017, to an individual who receives home health services for which payment is made under section 1895(b). > > > #### “(2) Applicable disposable device > > In this subsection, the term applicable disposable device means a disposable device that, as determined by the Secretary, is— > > > ##### “(A) > > a disposable negative pressure wound therapy device that is an integrated system comprised of a non-manual vacuum pump, a receptacle for collecting exudate, and dressings for the purposes of wound therapy; and > > > ##### “(B) > > a substitute for, and used in lieu of, a negative pressure wound therapy durable medical equipment item that is an integrated system of a negative pressure vacuum pump, a separate exudate collection canister, and dressings that would otherwise be covered for individuals for such wound therapy. > > > #### “(3) Payment amount > > The separate payment amount established under this paragraph for an applicable disposable device for a year shall be equal to the amount of the payment that would be made under section 1833(t) (relating to payment for covered OPD services) for the year for the Level I Healthcare Common Procedure Coding System (HCPCS) code for which the description for a professional service includes the furnishing of such device.” > . ###
(b)Conforming Amendments ####
(1)Coinsurance Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended— #####
(A)by striking “and (Z)” and inserting “(Z)”; and #####
(B)by inserting before the semicolon at the end the following: “, and
(AA)with respect to an applicable disposable device (as defined in paragraph
(2)of section 1834(s)) furnished to an individual pursuant to paragraph
(1)of such section, the amount paid shall be equal to 80 percent of the lesser of the actual charge or the amount determined under paragraph
(3)of such section”. ####
(2)Home health Section 1861(m)(5) of the Social Security Act (42 U.S.C. 1395x(m)(5)) is amended by inserting “and applicable disposable devices (as defined in section 1834(s)(2))” after “durable medical equipment”. ###
(c)Reports ####
(1)GAO study and report on disposable devices #####
(A)Study The Comptroller General of the United States shall conduct a study on the value of disposable devices to the Medicare program and Medicare beneficiaries and the role of disposable devices as substitutes for durable medical equipment. Such study shall address the following: ######
(i)The types of disposable devices that could potentially qualify as being substitutes for durable medical equipment under the Medicare program, the similarities and differences between such disposable devices and the durable medical equipment for which they would be a substitute, and the extent to which other payers, including the Medicaid program and private payers, cover such disposable devices. ######
(ii)Views of, and information from, medical device manufacturers, providers of services, and suppliers on the incentives and disincentives under current Medicare coverage and payment policies for disposable devices that are substitutes for durable medical equipment and how such policies affect manufacturers’ decisions to develop innovative products and providers’ and suppliers’ decisions to use such products. ######
(iii)Implications of expanding coverage under the Medicare program to include additional disposable devices that are substitutes for durable medical equipment. ######
(iv)Payment methodologies that could be used to pay for disposable devices that are substitutes for durable medical equipment other than applicable disposable devices pursuant to the amendments made by subsections
(a)and (b). ######
(v)Other applicable areas determined appropriate by the Comptroller General. #####
(B)Report Not later than 18 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress and the Secretary of Health and Human Services a report on the study conducted under subparagraph (A), together with recommendations for such legislation and administrative action as the Comptroller General determines to be appropriate. ####
(2)GAO study and report on the impact of the payment of applicable disposable devices #####
(A)Study The Comptroller General of the United States shall conduct a study on the impact of the payment for applicable disposable devices (as defined in section 1834(s)(2) of the Social Security Act) under the provisions of, and the amendments made by, subsections
(a)and (b). Such study shall address the following: ######
(i)The impact on utilization and Medicare program and beneficiary spending as a result of such provisions and amendments. ######
(ii)The type of Medicare beneficiaries who, under the home health benefit, use the applicable disposable device and the period of use of the applicable disposable devices compared to the beneficiaries who use the substitute durable medical equipment and their period of use. ######
(iii)How payment rates of other payers, including the Medicaid program and private payers, for applicable disposable devices compare to the payment rates for such devices under such provisions and amendments. ######
(iv)Other applicable areas determined appropriate by the Comptroller General. #####
(B)Report Not later than 4 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress and the Secretary of Health and Human Services a report on the study conducted under subparagraph (A), together with recommendations for such legislation and administrative action as the Comptroller General determines to be appropriate. ###
(d)Effective Date **[**[42 U.S.C. 1395l note](/us/usc/t42/s1395l)**]** The amendments made by this section shall apply to items furnished on or after January 1, 2017. # Title VI PUERTO RICO
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