S. 3763 — ALS Better Care Act

This section states 12 congressional findings concerning amyotrophic lateral sclerosis (ALS), including its progressive neurodegenerative nature; the importance of multidisciplinary services (e.g., specialized physician support, therapies, nursing, dietary and respiratory support, and durable medical equipment coordination) in extending patient lifespans and improving quality of life; inadequate Medicare reimbursements for such services, which cause facility challenges, wait times, and reduced innovation; the need for improved reimbursements to spur research and technology investments; the critical role of telehealth in providing timely care to rural or mobility-limited patients; and insufficient funding and staffing for ALS clinical trials, which delay treatments.

This section establishes Medicare Part B coverage for ALS-related services (i.e., specialized outpatient 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 by or under arrangement with a qualified provider) furnished on or after January 1, 2027, to covered ALS individuals (i.e., those medically determined to have amyotrophic lateral sclerosis as described in SSA section 226(h)). It directs the Secretary to pay qualified providers (as defined in new SSA section 1834(aa)(6)) a single add-on amount per visit for such services, in addition to other Part B payments: $800 in 2027 and 2028 (or greater in 2028 if recommended by the Comptroller General); for 2029 and later, the prior year's amount increased by the ALS services market basket percentage increase (or a greater Comptroller General recommendation in 2030 and every third year thereafter). It requires Comptroller General reports to Congress and the Secretary by January 1, 2027, and every third year thereafter recommending payment amounts based on estimated costs from Medicare, private insurer, or MA plan data (or other sources) for the highest-utilization year in specified covered periods (e.g., 2022-2024 for the first report). It directs payment adjustments (1) for qualified providers participating in at least one NIH-listed clinical trial and (2) for new medical services or technologies furnished as part of ALS-related services. It ensures that otherwise payable outpatient department services for covered ALS individuals remain eligible for payment 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 (NINDS) of the National Institutes of Health, to submit to Congress and publish on the agency's website, not later than 90 days after enactment, a report identifying (1) challenges with respect to the administration and staffing of clinical trials for the prevention, diagnosis, mitigation, treatment, or cure of amyotrophic lateral sclerosis; (2) actions the NINDS Director can take to address such challenges; and (3) legislative recommendations (including requests for appropriations) to further improve the administration of such clinical trials.