CQRC Applauds Introduction of the SOAR Act in U.S. Senate
March 1, 2024
Bipartisan bill safeguards access to supplemental oxygen to improve outcomes and well-being for an estimated 1.5 million Medicare beneficiaries
Washington, D.C. – The Council for Quality Respiratory Care (CQRC) – a coalition of the nation’s leading home respiratory therapy providers and manufacturing companies – today applauds the introduction of the bipartisan Supplemental Oxygen Access Reform (SOAR) Act (S. 3821). This landmark legislation, led by Sens. Bill Cassidy (R-LA), Mark Warner (D-VA), and Amy Klobuchar (D-MN), addresses the pressing challenges in the availability and delivery of supplemental oxygen to Medicare patients. If enacted into law, the SOAR Act will greatly enhance the lives of those living with serious respiratory and pulmonary conditions.
“The SOAR Act represents a significant step towards ensuring comprehensive oxygen reform. The CQRC thanks Senators Cassidy, Warner, and Klobuchar for their leadership on this bill and urges Congress to seize this opportunity and advance the SOAR Act without delay,” said Dan Starck, Interim Chair of the Council for Quality Respiratory Care.
Supplemental oxygen is a lifeline for individuals facing severe asthma, pneumonia, sleep apnea, chronic obstructive pulmonary disease (COPD), and cystic fibrosis. Access to this essential therapy is a matter of life or death for a highly vulnerable patient population. It is also an essential lifeline that allows individuals with serious respiratory conditions to continue to leave their home and participate in their communities. Under current law, existing federal policies often undercut the ability of patients to access the medically necessary treatments their doctors prescribe.
To help streamline respiratory patients’ access to care and improve the ability of providers to reach patients, the SOAR Act encompasses vital reforms, including:
- Removal of supplemental oxygen from Medicare’s competitive bidding program
- Permanent extension of Medicare’s blended payment rates
- Establishment of a separate payment system for liquid oxygen to restore access for those patients who need this modality
- Create reimbursement for respiratory therapist services consistent with State laws
- Mandate the use of the oxygen template to prevent unwarranted claims denials
One pivotal policy proposed by the SOAR Act is to reform the current Medicare reimbursement system for these life-sustaining treatments. A study undertaken by the American Thoracic Society (ATS) noted that Medicare’s competitive bidding program (CBP) has created barriers to access supplemental oxygen equipment, supplies and services, particularly when it relates to the availability of liquid oxygen. Since its inception, the CPB has substantially reduced Medicare expenditures for supplemental oxygen. The program has achieved the intent of the Congress to right-size expenditures, but at the expense of some patients being able to access this essential equipment. The SOAR Act establishes a revised payment methodology based on current rates, including the blended rates for rural and other non-urban areas. To address the access problems created under the current reimbursement structure, the legislation would realign payment to protect access to supplemental liquid oxygen.
Furthermore, the SOAR Act recognizes the critical role of respiratory therapist services. To protect and expand access to respiratory therapists, the SOAR Act creates an add-on payment to supplemental oxygen rates when respiratory therapist services are provided, consistent with state laws.
The bill also eliminates the current requirement that physicians turn over patients’ medical records for establishing medical necessity, which has resulted in substantial denials based on the wording of the medical record rather than on the patients’ medical need. In lieu of medical record notes, the bill calls for a standardized, electronic template with clinical data elements for documenting medical necessity aimed at simplifying and streamlining the complex process of retroactively reviewing patient records. This reform is expected to significantly reduce delays in care and increase access to supplemental oxygen.
Underscoring Congress’ attention to this vital issue, a bipartisan groups of House lawmakers sent a letter to the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure last year urging the clarification of Medicare documentation requirements for supplemental oxygen and the adoption of a standardized template for documenting patient needs. According to the CQRC, the use of a standardized, electronic template will eliminate frustrating and nonsensical hurdles for an already vulnerable patient population.
Added Starck, “This bipartisan legislation is a beacon of hope for patients, caregivers, healthcare providers, and communities, promising improved access to supplemental oxygen and respiratory therapy to safeguard and enhance health and quality of life.”
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