H.R. 10787
Access to Medical Supplies Act
Sponsor: Gregory F. Murphy
2 cosponsors
Official summary
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Text of the bill
This Act may be cited as the Access to Medical Supplies Act.
Section 1847(a)(2)(A) of the Social Security Act (42 U.S.C. 1395w–3(a)(2)(A)) is amended by inserting excluding urological and ostomy supplies (as defined in section 1861(s)(8) furnished on or after January 1, 2028, and before January 1, 2033), before and excluding drugs and biologicals..
Section 1847 of the Social Security Act (42 U.S.C. 1395w–3) is amended by adding at the end the following new subsection:
(g) Technical expert panel review and analyzation of the impact of including urological and ostomy supplies in competitive acquisition programs under the Medicare program
(1) In general. Not later than 90 days after the date of the enactment of this subsection, the Secretary (through use of a contractor or otherwise) shall establish a technical expert panel for purposes of reviewing the impact of including urological and ostomy supplies in the competitive acquisition programs under this section and recommending changes to such programs.
(2) Review, assessment, and recommendations. Not later than 1 year after the date the technical expert panel described in paragraph (1) is established (and periodically thereafter as the Secretary determines appropriate), the technical expert panel shall review stakeholder input and clinical literature and make recommendations to the Secretary with respect to including urological and ostomy supplies in the competitive acquisition programs under this section, including recommendations regarding how such programs, at a minimum—
(A) shall be administered in a manner in which the needs of patients, as determined by their physicians, are met through the widespread availability of specialized products to meet patient needs;
(B) ensure that bids are submitted at a level that will allow beneficiaries to access the same range of products selected by ordering physicians prior to the implementation of the competitive acquisition program;
(C) address other issues that the technical expert panel determines appropriate.
(3) Membership. In establishing the technical expert panel, the Secretary shall solicit recommendations from interested stakeholders. The technical expert panel shall be composed of a minimum of 15 individuals with relevant expertise and perspectives, including the following:
(A) Home urological and ostomy supply patients and caregivers.
(B) Experts with relevant clinical experience and expertise, including researchers and other clinicians.
(C) Experts with subject matter expertise in reimbursement systems and medical necessity requirements under this title.
(D) Experts in the supply of devices and services for urological and ostomy supplies.
(E) Experts in the design, development, and manufacturing of urological and ostomy supplies.
(4) Use of the recommendations by the Secretary. The Secretary shall implement the competitive acquisition program consistent with the recommendations described in paragraph (2).
(5) Transparency. The Secretary shall make the minutes of all meetings of the technical expert panel and all documentation relating to the formulation of recommendations described in paragraph (2) available to the public through the website of the Centers for Medicare & Medicaid Services.
Section 1847 of the Social Security Act (42 U.S.C. 1395w–3), as amended by section 3, is amended by adding at the end the following new subsection:
(h) Establishment of demonstration project To assess inclusion of urological and ostomy supplies in the competitive acquisition programs
(1) In general. Not later than three years after the date of the enactment of this subsection, the Secretary shall conduct a demonstration project to test the inclusion of urological and ostomy supplies in the competitive acquisition program that assess the impact on beneficiary access and health outcomes. The Secretary shall use the results of the demonstration project to include such medical products in the competitive acquision program in a manner that—
(A) ensures individuals can access the same or clinically comparable medical supply products as determined by treating physicians;
(B) ensures positive individual health outcomes;
(C) ensures bidders can provide brand name medical supply products individuals used prior to the implementation of any demonstration or competitive acquisition program; and
(D) includes recommendations from the technical expert panel described in subsection (g).
(2) Demonstration project size and length. The demonstration project shall be conducted in not more than 3 States and be conducted for 12 months.
(3) Survey
(A) In general. Prior to conducting the demonstration project, the Secretary shall survey a representative sample of individuals residing in the demonstration project bid area who used urological and ostomy supplies in the previous calendar year to determine which products such individuals have been utilizing.
(B) Resurvey. Not later than 3 months after the start of the demonstration project, the Secretary shall survey the same individuals described in subparagraph (A) to determine whether they are able to continue accessing the same medical supplies. If the individuals are not able to access the same medical supplies, the Secretary shall consult with the technical expert panel described in subsection (g) to provide recommended changes to address the access issue.
Section 1847 of the Social Security Act (42 U.S.C. 1395w–3), as amended by sections 3 and 4, is amended by adding at the end the following new subsection:
(i) Prohibition on influencing and incentivizing and right To purchase the same or clinically comparable urological and ostomy supplies
(1) In general. A contract supplier may not attempt to influence or incentivize an individual to switch the brand of urological or ostomy supplies selected by the referring physician and individual, including by—
(A) persuading, pressuring, or advising the individual to switch; or
(B) furnishing information about alternative brands to the individual where the individual has not requested such information.
(2) Individual right to purchase same or clinically comparable urological and ostomy supplies
(A) In general. The Secretary shall establish a process to ensure that individuals receiving urological or ostomy supplies under a demonstration or other competitive acquisition program can access the same or clinically comparable urological or ostomy supplies as such individuals did prior to implementation of such demonstration or program.
(B) Right to purchase. The process established in subparagraph (A) shall specify that if the individual cannot access the same or clinically comparable urological or ostomy supplies as required under subparagraph (A), the individual has the right to receive such urological and ostomy supplies from another supplier, or a non-contract supplier.