The proposed legislation, known as the "Supplemental Oxygen Access Reform Act of 2024" or the "SOAR Act", aims to amend Title XVIII of the Social Security Act, significantly altering the payment methods and access to oxygen-related equipment and services for Medicare beneficiaries. By reforming payment structures and establishing beneficiary rights, the bill seeks to enhance the overall accessibility and delivery of supplemental oxygen therapy both at home and within communities.

General Summary of the Bill

The SOAR Act outlines several major changes to the existing Medicare benefits concerning oxygen and related services. Notably, it removes oxygen and related equipment from the competitive acquisition program starting in 2025, aiming to improve patient access. It also sets new payment guidelines that account for economic adjustments, and it requires defining supplier responsibilities to ensure comprehensive care. Additionally, the legislation introduces new reimbursement guidelines for respiratory therapist services, mandates the use of electronic templates for documentation, and establishes a series of rights for individuals receiving oxygen services, including the right to choose suppliers and expect 24-hour support.

Significant Issues

• Financial Implications: One of the most significant issues is the proposed non-budget neutral add-on for patients who require high-flow oxygen. This could potentially increase Medicare spending without clear justification or evaluation of its financial sustainability.

• Supplier Responsibilities: The bill introduces detailed requirements for oxygen suppliers, including 24-hour on-call coverage, which could impose significant costs, particularly on smaller suppliers. This may reduce their participation in Medicare, impacting service availability.

• Use of Technology: The mandate for electronic templates and transactions presents a potential disadvantage for smaller or less technologically equipped entities, as it may favor larger organizations capable of meeting these requirements.

• Reimbursement and Add-On Payments: The inclusion of respiratory therapist services with a non-budget neutral payment adjustment raises concerns about budgetary impacts, with no clear funding source provided.

• Potential Overpayments: The transitional interim payment for liquid oxygen, set at 200% of the 2015 fee schedule, suggests the risk of overpayments, raising questions about resource efficiency.

Broad Public and Stakeholder Impact

Broad Public Impact:

• Access to Services: By ensuring better access to necessary oxygen-related equipment, the bill could improve the quality of life for many Medicare beneficiaries who rely on these services.

• Cost Considerations: While the bill targets improved access, it may inadvertently lead to increased costs for the Medicare program, potentially impacting beneficiaries if costs are passed down.

• Technological Barriers: The push for adopting electronic methods might mean better efficiency in processing claims and documentation. However, it could pose challenges for those less familiar with or without access to such technologies, affecting patients in rural or low-tech areas.

Impact on Specific Stakeholders:

• Oxygen Suppliers and Manufacturers: The bill could benefit suppliers of liquid oxygen disproportionately through specific rules and payment floors, as well as to those who can meet the extensive criteria set for service delivery.

• Small Suppliers: The financial burden and administrative requirements might lead smaller suppliers to opt out of Medicare participation, reducing competition and potentially increasing prices.

• Respiratory Therapists: Expanding the list of covered services to include respiratory therapists could lead to greater job security and demand for these professionals, benefiting the workforce within this sector.

• Healthcare Providers and Patients: The clarified rights and responsibilities could enhance patient-provider relationships and ensure patients receive adequate care and support, minimizing risks related to service delivery.

Overall, while the SOAR Act seeks to address several areas related to supplemental oxygen therapy, ongoing concerns regarding cost management, fair competition, and implementation processes will require careful consideration to ensure the anticipated benefits are realized without unintended negative consequences.