SOAR Act of 2025
- Sponsor
- Sen. Cassidy, Bill [R-LA]
- Committees
- Finance Committee (primary)
- Last action
- Apr 10, 2025
Bottom line
The bill overhauls Medicare's oxygen benefit to improve patient access, enhance service quality, and ensure sustainable reimbursement for suppliers, while also bolstering patient protections and program oversight.
What it actually does
This bill amends the Social Security Act to reform Medicare's payment method for supplemental oxygen therapy, removing oxygen and related equipment from the competitive acquisition program. It establishes new payment rates, defines comprehensive supplier responsibilities, mandates Medicare reimbursement for respiratory therapist services, and implements measures to strengthen program integrity and establish explicit beneficiary rights for oxygen therapy.
Proponents argue
Supporters argue that the current competitive bidding system has led to inadequate reimbursement rates, resulting in reduced access to essential oxygen therapy, particularly for liquid oxygen and in rural areas. They contend this bill will stabilize the market, ensure suppliers can provide necessary equipment and services, and guarantee beneficiaries receive comprehensive care, including vital support from respiratory therapists.
Opponents contend
Critics might argue that removing oxygen from competitive bidding could lead to increased Medicare costs without sufficient evidence of improved quality or efficiency. They may also contend that the proposed payment increases could be overly generous, benefiting suppliers at taxpayer expense, and that the new regulatory burdens on suppliers might lead to unintended consequences.
The bill is moderately detailed, requiring careful reading to understand the specific payment formulas and new criteria, but is accessible to an informed reader.
Sec. 101(a); Section 1847(a)(3) of the Social Security Act (42 U.S.C. 1395w-3(a)(3))
Exclusion of Oxygen from Competitive Bidding
This provision mandates that, starting January 1, 2026, oxygen and related equipment, supplies, and services will be excluded from Medicare's competitive acquisition program. Instead, payment for these items will be determined by new methods outlined elsewhere in the bill, aiming to stabilize reimbursement and improve access.
Supporters argue
Competitive bidding has driven down reimbursement rates to unsustainable levels, leading to supplier consolidation, reduced service quality, and limited access for beneficiaries, particularly in rural and non-contiguous areas. Removing oxygen from this program will stabilize the market and ensure patient access.
Critics contend
Competitive bidding was designed to reduce Medicare costs and ensure efficient use of taxpayer dollars. Removing oxygen from this program could lead to higher costs for Medicare and beneficiaries without guaranteed improvements in care quality.
Tradeoffs
Balancing cost containment for Medicare with ensuring adequate access and quality of care for beneficiaries.
Sec. 101(b); Section 1834(a)(9) of the Social Security Act (42 U.S.C. 1395m(a)(9))
New Payment Methodology for Oxygen and Related Services
This section establishes new payment amounts for oxygen and related services starting January 1, 2026. It sets different formulas for competitive bidding areas, rural/non-contiguous areas, and other areas, generally involving a blend of existing fee schedules and national average prices, with annual updates based on the Consumer Price Index (CPI). It also creates a special payment rule for liquid oxygen, including a payment floor, an update mechanism, a monthly add-on for high-flow patients, and periodic assessments.
Sec. 102; Section 1834(a)(9) of the Social Security Act (42 U.S.C. 1395m(a)(9))
Oxygen Supplier Responsibilities Criteria
This section mandates the Secretary to define a comprehensive scope of services that oxygen suppliers must provide to receive Medicare payment, effective one year after enactment. These responsibilities include initial beneficiary evaluations, ensuring access to portable oxygen, providing education to beneficiaries and caregivers, timely delivery and setup, equipment maintenance, monitoring visits (including by respiratory therapists), documentation, 24-hour on-call coverage, and assistance with travel or permanent relocation.
Sec. 201(a); Section 1861(s)(2) and 1861 of the Social Security Act (42 U.S.C. 1395x(s)(2) and 1395x)
Medicare Coverage for Respiratory Therapist Services
This provision 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 the assessment, treatment, and monitoring of patients requiring oxygen and related equipment, supplies, or services.
Sec. 201(b); Section 1834(a)(9) of the Social Security Act (42 U.S.C. 1395m(a)(9))
Monthly Payment Add-On Adjustment for Respiratory Therapist Services
This section mandates the Secretary to implement a non-budget neutral add-on payment adjustment to the oxygen payment amount for respiratory therapist services furnished on or after January 1, 2026. This add-on is intended to reflect the cost of providing these services as clinically appropriate under State law, ensuring suppliers are compensated for RT involvement.
Sec. 301(a); Section 1834(a)(5) of the Social Security Act (42 U.S.C. 1395m(a)(5))
Electronic Templates for Medical Necessity Documentation
This provision requires the Secretary to adopt an electronic template, starting January 1, 2026, for prescribing practitioners to document the medical necessity of oxygen and related equipment. This template will be the complete request for information, requiring documentation of beneficiary visits, qualifying blood gas/saturation test results, and appropriate equipment use, but explicitly prohibits requiring medical record notes. Medicare administrative contractors must use electronic transactions for claims adjudication.
Sec. 301(b); Section 1834(a)(5) of the Social Security Act (42 U.S.C. 1395m(a)(5))
Restoration of Clinical Inference in Payment Audits
This section mandates that for claims submitted on or after the enactment date, the Secretary must use clinical inference and judgment in evaluating templates, medical records, and orders during payment audits for oxygen and related services. This is to be done in the same manner as before 2009, allowing for a more contextual review of documentation.
Sec. 401; Section 1834(a)(5) of the Social Security Act (42 U.S.C. 1395m(a)(5))
Oxygen Beneficiary Bill of Rights
This section mandates the Secretary to establish, through regulation, a comprehensive set of rights for individuals receiving oxygen therapy. These rights include choosing a supplier, clear communication, privacy, being informed about services and the right to refuse treatment, equipment maintenance, timely repairs/replacements, assistance during travel, emergency back-ups, power outage plans, and grievance processes. It also sets rules for involuntary discharge by suppliers.
The electronic template for medical necessity documentation "shall not require the prescribing practitioner to provide medical record notes regarding the beneficiary."
Sec. 301(a)(ii)(IV); Section 1834(a)(5) of the Social Security Act (42 U.S.C. 1395m(a)(5))
Why it matters:This is likely standard legislative practice to include specific exclusions or limitations within broader mandates, though it could be overlooked by a casual reader focusing on the general requirement for templates.
Case for: Proponents argue that this exclusion significantly reduces the administrative burden on prescribing practitioners, allowing them to focus more on patient care rather than extensive paperwork, while still providing essential information for medical necessity.
Case against: Critics might contend that excluding medical record notes could limit the comprehensive clinical context available for auditors, potentially making it harder to verify medical necessity in complex cases and increasing the risk of fraud if other documentation is insufficient.
Estimated impact: Potentially reduces administrative overhead for thousands of prescribing practitioners involved in oxygen therapy.
The add-on amount for high-flow liquid oxygen patients shall equal "the per pound cost of the oxygen exceeding the amount required to provide a liter flow that is equal to or greater than 6 liters per minute."
Sec. 101(b)(F)(iii)(II); Section 1834(a)(9) of the Social Security Act (42 U.S.C. 1395m(a)(9))
Why it matters:This level of detail is typical for payment methodology specifications in legislation, ensuring precision in implementation rather than being intentionally obscured.
Case for: Proponents argue this precise calculation ensures that suppliers are adequately compensated for the higher volume of liquid oxygen required by high-flow patients, addressing a specific cost burden that current payment models often fail to cover.
Case against: Opponents might argue that such a specific, volume-based add-on could incentivize over-prescription or over-provision of oxygen if not carefully monitored, potentially leading to increased costs without proportional clinical benefit.
Estimated impact: Provides additional reimbursement for a subset of oxygen-dependent beneficiaries with high clinical needs, potentially improving access to appropriate therapy for this group.
Establishes detailed procedures for a supplier involuntarily discharging an individual, including a 30-day written notice and adherence to established or abbreviated discharge procedures.
Sec. 401(xiii); Section 1834(a)(5) of the Social Security Act (42 U.S.C. 1395m(a)(5))
Why it matters:While important, the detailed procedural aspects of discharge are often placed within comprehensive lists of rights or responsibilities, which is a common legislative structure.
Case for: Proponents argue that these procedures are essential to protect vulnerable oxygen-dependent patients from abrupt discontinuation of life-sustaining services, ensuring continuity of care and preventing adverse health outcomes.
Case against: No specific opposition is typically raised against basic patient protections like these, though some suppliers might express concerns about the administrative burden of strict adherence to discharge protocols, especially in emergency situations.
Estimated impact: Provides a safety net for beneficiaries, ensuring they are not left without critical medical equipment due to supplier-initiated discharge.