H.R. 7336 — ALS Better Care Act

This section states congressional findings concerning amyotrophic lateral sclerosis (ALS), including that (1) ALS is a progressive neurodegenerative disease requiring multidisciplinary services (e.g., specialized physician support, therapies, nursing, and durable medical equipment) that ALS clinics provide to extend patient lifespans and improve quality of life; (2) Medicare reimbursement for such services is inadequate, causing facility challenges such as extended wait times and reduced innovation; (3) improved reimbursement would support research and enhanced outcomes; and (4) telehealth is essential for access—particularly for rural patients with mobility limitations—and insufficient funding and staffing impede ALS clinical trials.

This section establishes Medicare Part B coverage for ALS-related services (i.e., specialized physician or nurse practitioner support, occupational therapy support, speech pathology support, physical therapy, dietary support, respiratory support, registered nurse support, and coordination of durable medical equipment) furnished on or after January 1, 2027, to covered ALS individuals (i.e., those medically determined to have amyotrophic lateral sclerosis) in outpatient settings by qualified providers (as defined in section 1834(aa)(6)). The section further directs the Secretary to make a single add-on payment to such providers for ALS-related services furnished during a visit, in addition to other payments under Medicare: $800 in 2027 and $800 (or greater, if recommended) in 2028; for 2029 and subsequent years, the prior year's amount increased by the ALS services market basket percentage increase (or a Comptroller General recommendation, if greater, in 2030 and every third year thereafter). It requires the Comptroller General, by January 1, 2027, and every third year thereafter, to submit a report recommending a payment amount based on estimated average payments for such services under Medicare (using highest-utilization year from specified covered periods), private health insurance and Medicare Advantage plans, or other sources. The section also includes payment adjustments for qualified providers participating in clinical trials and for new medical services or technologies furnished as part of ALS-related services; and ensures that otherwise payable outpatient department services for covered ALS individuals remain eligible under existing rules notwithstanding payments under this provision.

This section directs the Secretary of Health and Human Services, acting through the Director of the National Institute of Neurological Disorders and Stroke, to submit to Congress and publish online a report within 90 days of enactment identifying (1) challenges in the administration and staffing of clinical trials for amyotrophic lateral sclerosis (ALS), (2) actions the Director can take to address those challenges, and (3) legislative recommendations (including appropriation requests) to improve administration of such trials.