SOAR Act of 2025
- Sponsor
- Rep. Valadao, David G. [R-CA-22]
- Committees
- Ways and Means Committee (primary)
- Last action
- Apr 10, 2025
Bottom line
This bill aims to enhance access to and quality of supplemental oxygen therapy for Medicare beneficiaries by revising payment structures, increasing provider accountability, and formalizing beneficiary protections.
What it actually does
This bill reforms Medicare's payment system for oxygen and oxygen-related equipment, supplies, and services by removing them from the competitive acquisition program and establishing new fee schedules. It also defines comprehensive supplier responsibilities, formally recognizes and reimburses respiratory therapist services, mandates electronic templates for medical necessity documentation, and establishes a robust set of beneficiary rights for oxygen therapy. The changes aim to improve access and quality of care for Medicare beneficiaries requiring supplemental oxygen.
Proponents argue
Proponents argue that the current competitive bidding program for oxygen has led to significant access issues, reduced quality of care, and financial instability for suppliers, particularly in rural areas. They contend that this bill will stabilize the market, ensure beneficiaries receive appropriate and timely oxygen therapy, improve safety, and recognize the critical role of respiratory therapists in patient care.
Opponents contend
Opponents might argue that removing oxygen from competitive bidding could lead to increased Medicare costs, potentially burdening taxpayers. They might also contend that the new payment rates could be excessive, and that the detailed supplier responsibilities, while well-intentioned, could create administrative burdens that disproportionately affect smaller providers or lead to unintended consequences in service delivery.
The bill is moderately detailed, requiring careful reading of payment formulas and new definitions. The estimated reading time of 15-20 minutes is appropriate for a thorough understanding.
Section 101(a)
Exclusion of Oxygen from Competitive Bidding
This provision mandates that, starting January 1, 2026, oxygen and related equipment, supplies, and services will no longer be subject to Medicare's competitive acquisition program. Instead, payment will be determined by new fee schedules established elsewhere in the bill, aiming to stabilize reimbursement and improve access.
Supporters argue
Supporters argue that competitive bidding for oxygen has led to significant reductions in reimbursement, forcing many suppliers out of business, particularly in rural areas, and limiting beneficiary access to necessary equipment and services. Removing oxygen from this program is seen as essential to restoring access and ensuring quality of care.
Critics contend
Critics of this change might argue that competitive bidding was designed to control Medicare costs and ensure efficient use of taxpayer dollars. Removing oxygen from this program could lead to higher costs for the Medicare program and, ultimately, for taxpayers, without guaranteed improvements in quality or access that justify the increased expenditure.
Tradeoffs
This provision balances the goal of cost containment (achieved through competitive bidding) against the goals of ensuring patient access and supplier viability, particularly in less densely populated or economically challenging areas.
Section 101(b)
New Fee Schedule for Oxygen and Related Services
This section establishes new payment amounts for oxygen and related services, effective January 1, 2026. It sets different formulas for competitive bidding areas, rural/non-contiguous areas, and other areas, generally basing payments on a combination of 2025 fee schedules, national averages, and CPI-U updates. It also includes special rules for liquid oxygen, setting a payment floor and an add-on for high-flow patients.
Section 102(a)
Comprehensive Supplier Service Requirements
This section mandates that the Secretary, in consultation with stakeholders, define a comprehensive scope of services oxygen suppliers must provide to receive Medicare payment, effective one year after enactment. These responsibilities include initial patient evaluation, ensuring portable oxygen access, providing extensive patient and caregiver education, timely delivery and setup, equipment maintenance, monitoring visits (including by respiratory therapists), 24-hour on-call coverage, and assistance with travel or relocation.
Section 201
Medicare Coverage and Add-On Payment for Respiratory Therapist Services
This section adds "respiratory therapist services" to the definition of medical and other health services covered by Medicare, effective January 1, 2026. It defines these services as those performed by a respiratory therapist within their scope of practice for assessing, treating, and monitoring patients requiring oxygen. It also mandates a non-budget neutral add-on payment adjustment to oxygen payments to reflect the cost of these services.
Section 301(a)
Streamlined Documentation and Restored Clinical Judgment
This section requires the Secretary to adopt an electronic template, effective January 1, 2026, for prescribing practitioners to document medical necessity for oxygen and related services. This template will constitute the complete request for information, avoiding additional medical record notes. It also mandates the restoration of clinical inference and judgment in payment audits for oxygen suppliers, similar to practices before 2009.
Section 401
Comprehensive Beneficiary Rights for Oxygen Therapy
This section mandates the Secretary to establish, through regulation, a comprehensive set of rights for individuals receiving oxygen or related services. These rights include choosing a supplier, clear communication, privacy, informed consent regarding treatment and financial responsibilities, access to appropriate equipment (including for mobility and emergencies), timely repairs, assistance during travel, and robust grievance processes, including protections against retaliation.
This provision mandates a monthly payment add-on adjustment for respiratory therapist services, explicitly stating it will be "non-budget neutral." This means the additional costs for these services will not be offset by reductions elsewhere in the Medicare program.
Section 201(b)
Why it matters:This phrasing is standard legislative practice for indicating that a new expenditure is not required to be offset by savings within the same program or budget window. It's not necessarily evasive but requires specific knowledge to fully appreciate its impact.
Case for: Proponents argue that making this add-on non-budget neutral is essential to ensure that respiratory therapists are adequately compensated for their critical services without forcing cuts to other vital oxygen-related benefits. They contend that the value of improved patient outcomes justifies the direct additional cost.
Case against: Critics might argue that any new Medicare expenditure should ideally be budget-neutral to prevent increasing the national debt or burden on taxpayers. They might suggest that a non-budget neutral provision indicates a lack of fiscal discipline or an unwillingness to identify offsetting savings.
Estimated impact: This provision will lead to an increase in Medicare expenditures related to oxygen therapy, the exact amount of which would depend on the established add-on rate and utilization of RT services.