S. 1406 — SOAR Act of 2025

This section excludes oxygen and oxygen-related equipment, supplies, and services from Medicare's durable medical equipment (DME) competitive acquisition program beginning January 1, 2026, with payments instead made under revised rules in section 1834(a)(9) of the Social Security Act. (As background, the competitive acquisition program sets DME payment rates via supplier bidding in selected areas to control costs, while oxygen payments have historically been subject to volume adjustments and area-specific fee schedules under 42 U.S.C. 1395m(a)(9).) The section establishes payment amounts for such excluded oxygen items furnished on or after January 1, 2026, as follows: (1) In competitive bidding areas, the 2026 fee schedule amount in effect on December 31, 2025, increased annually thereafter by the consumer price index for all urban consumers (CPI-U); (2) In rural and non-contiguous areas (Alaska, Hawaii, and U.S. territories), 50% of 110% of the national average price (per 42 C.F.R. 414.210(g)(1)(ii)) plus 50% of the 2026 fee schedule amount in effect on December 31, 2025 (or subsequent year amount), increased annually by CPI-U; and (3) In other areas, 75% of the adjusted payment under (1) plus 25% of the unadjusted fee schedule amount. For liquid oxygen and related items, the section further requires the Secretary to establish by January 1, 2026—via notice-and-comment rulemaking with stakeholder input—a separate payment amount that accounts for per-pound oxygen costs, equipment, infrastructure (e.g., labor, storage, transportation), and regulatory compliance costs, subject to a floor of 200% of the 2015 DME fee schedule amount updated by CPI-U for 2016-2025 and annual CPI-U increases beginning in 2027; a non-budget-neutral monthly add-on for high-flow patients (oxygen flow rate of 6 liters per minute or greater) equal to the per-pound cost exceeding that flow rate; and a required assessment of payment adequacy at least every three years. (Thus, these changes aim to ensure sufficient reimbursement for liquid oxygen, which requires specialized handling compared to gaseous oxygen.)

This section directs the Secretary of Health and Human Services (HHS), in consultation with stakeholders, to define the scope of services that suppliers of oxygen and oxygen-related equipment, supplies, and services must provide to receive payment under Medicare Part B (i.e., the 80% coinsurance payment basis for durable medical equipment such as stationary and portable oxygen prescribed for home use by beneficiaries with qualifying respiratory conditions). The required services include (1) initial beneficiary evaluation using a uniform oxygen patient evaluation form; (2) ensuring access to portable oxygen based on mobility needs, including outside the home; (3) beneficiary and caregiver education on oxygen safety and options; (4) timely delivery, setup, and coordination; (5) safety and infection control instructions; (6) equipment maintenance and purity checks; (7) necessary monitoring visits by personnel such as respiratory therapists; (8) exception reporting to prescribing physicians; (9) ongoing education and supplies per the plan of care; (10) 24-hour on-call coverage; and (11) assistance with coordination or supplier transitions for travel or relocation. The requirements take effect one year after enactment.

This section (1) adds respiratory therapist services (i.e., services performed by a respiratory therapist within the scope of state-defined practice for assessing, treating, and monitoring patients requiring oxygen and related equipment, supplies, or services) to Medicare Part B covered medical and other health services furnished on or after January 1, 2026; and (2) requires the Secretary, through notice-and-comment rulemaking and in consultation with stakeholders, to establish a non-budget-neutral add-on payment adjustment to oxygen equipment payments (under SSA §1834(a)(9)) to reflect the cost of providing such services as clinically appropriate under state law, effective January 1, 2026.

This section requires the Secretary, with respect to Medicare payment for oxygen and oxygen-related equipment, supplies, and services under the durable medical equipment (DME) benefit— (1) for items furnished on or after January 1, 2026, to adopt an electronic template to be completed by the prescribing practitioner as the complete documentation of medical necessity (i.e., under SSA §1862(a)(1)(A)), requiring certification timeframes, qualifying blood gas or saturation test results, beneficiary need or use, and any other Secretary-determined information except medical record notes; and requires Medicare administrative contractors to adjudicate such claims electronically; and (2) for audits of supplier claims submitted on or after the date of enactment, to apply clinical inference and judgment when evaluating templates, records, and orders, as under pre-2009 contractor instructions.

This section requires the annual Medicare notice to beneficiaries to include (1) descriptions of the 36-month rental period for supplemental oxygen equipment, beneficiaries' rights to discuss prescriptions with prescribing physicians or practitioners, cost-sharing requirements for such equipment, supplies, and services (which terminate if a beneficiary refuses or discontinues therapy), and (2) information on suppliers' internal and external grievance processes (including Medicare hotline and ombudsman contacts and the right to file grievances without retaliation or service denial). The section further directs the Secretary, in consultation with stakeholders, to distribute monthly notices to beneficiaries receiving supplemental oxygen equipment, supplies, and services stating the number of months remaining in the 36-month rental cap period during which copayments apply. (As background, Medicare Part B covers rental of home supplemental oxygen equipment for up to 36 months, with beneficiary copayments required during that period; Medicare then assumes ownership with no further copays.)

This section directs the Secretary to establish through regulation a set of specified protections for Medicare beneficiaries (under Part B durable medical equipment payment rules) receiving oxygen or oxygen-related equipment, supplies, or services. These protections grant beneficiaries rights to (1) choose and change qualified local suppliers; (2) receive clear communications, privacy protections, and information on services, costs (including months remaining in the 36-month rental cap period), treatment options, supplier policies, and 24-hour on-call coverage; (3) obtain appropriate, mobile, and well-maintained equipment with timely repairs, deliveries per regulations, travel assistance, emergency supplies, and power outage plans; (4) refuse or discontinue treatment; and (5) receive advance notice and due process for any supplier involuntary discharge, along with access to internal and external grievance processes without retaliation.