SOAR Act of 2025
- Bill Number
- H.R. 2902
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-04-10: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-07-07T08:05:49Z
AI-Generated Summary
Purpose of the Legislation
The Supplemental Oxygen Access Reform Act of 2025 (SOAR Act of 2025), H.R. 2902, aims to update Medicare's coverage and payment rules for supplemental oxygen therapy provided in the home and community. It seeks to enhance access for beneficiaries, streamline payments to suppliers, reduce administrative burdens, strengthen fraud protections, and establish clear rights for patients receiving oxygen equipment, supplies, and services.
Key Provisions
The bill is divided into four titles, each addressing specific aspects of Medicare's oxygen benefit under Title XVIII of the Social Security Act.
Title I: Protect Beneficiary Access to Supplemental Oxygen Therapy in the Home and Community
- Reform of the Medicare Supplemental Oxygen Benefit (Sec. 101): Excludes oxygen and related equipment, supplies, and services from Medicare's competitive acquisition program (a bidding process for durable medical equipment) starting January 1, 2026, to improve patient access. Introduces new payment amounts based on location:
- In competitive bidding areas: Starts at 2025 fee schedule rates, updated annually by the Consumer Price Index for All Urban Consumers (CPI-U).
- In rural or non-contiguous areas (e.g., Alaska, Hawaii, territories): A blend of 50% national average price and 50% fee schedule, also CPI-U adjusted.
- Other areas: 75% of competitive area payment plus 25% unadjusted fee schedule.
- Special rules for liquid oxygen (a form of oxygen stored as a liquid for portability):
- Requires the Secretary of Health and Human Services (HHS) to set a separate payment rate by January 1, 2026, considering costs like production, delivery, and compliance with regulations; includes a minimum "payment floor" of 200% of the 2015 fee schedule (CPI-U adjusted through 2025).
- Annual CPI-U updates starting 2027; periodic reviews every three years.
- Add-on payment for high-flow patients (6+ liters per minute) covering extra oxygen costs.
- Transitional interim payment until full implementation.
- Establishes clinical coverage criteria, updated every five years, to ensure appropriateness and beneficiary independence.
- Establishment of Supplemental Oxygen Responsibilities Criteria (Sec. 102): Defines mandatory services suppliers must provide for Medicare payment, including initial evaluations, education on safety and use, timely delivery/setup, maintenance, 24-hour on-call support, infection control, and assistance with travel or supplier changes. Effective one year after enactment.
- Technical Corrections (Sec. 103): Updates Medicare definitions to include modern oxygen equipment, replacing outdated terms like "oxygen tents."
Title II: Protecting Beneficiary Access to Respiratory Therapists
- Reimbursement for Respiratory Therapists (Sec. 201): Adds respiratory therapist services (assessment, treatment, and monitoring of oxygen needs, as defined by state laws) to Medicare's covered "medical and other health services" starting January 1, 2026.
- Includes a non-budget neutral (not offset by cuts elsewhere) monthly add-on payment to oxygen suppliers' rates, reflecting the cost of involving respiratory therapists as needed under state rules. Developed via rulemaking with stakeholder input.
Title III: Adoption of Electronic Templates to Strengthen Fraud and Abuse Protections and Ensure Program Integrity
- Strengthening Program Integrity (Sec. 301): Mandates electronic templates for prescribing practitioners to document medical necessity for oxygen items starting January 1, 2026. Templates require proof of patient visits, test results (e.g., blood gas levels), equipment needs, but not full medical records.
- Medicare contractors must process claims electronically.
- Restores "clinical inference and judgment" in audits (allowing reviewers to use medical expertise, as done pre-2009), reducing overly rigid denials.
- Notice Requirements (Sec. 302):
- Adds to annual Medicare notices: Explanations of the 36-month rental period for oxygen equipment, cost-sharing (copayments), rights to discuss prescriptions, and grievance processes.
- Requires monthly notices to patients on remaining months of copayments during the rental period.
Title IV: Establishment of Beneficiary Rights
- Protections for Individuals Receiving Oxygen (Sec. 401): Establishes patient rights via regulation, including:
- Choice of qualified local suppliers and ability to switch.
- Clear communication, privacy of health information, and informed consent on treatments, costs, and refusals.
- Access to portable equipment for mobility, timely repairs/replacements, 24-hour support, and emergency plans (e.g., for power outages).
- Advance notice (30 days) for involuntary discharge by suppliers, except in safety emergencies.
- Assistance with travel, grievances without retaliation, and notifications of equipment changes (with doctor consultation rights).
Significant Changes to Existing Law
- Payment System Overhaul: Shifts oxygen from competitive bidding (which can limit supplier options and access) to a fee schedule-based system with location-specific rates and CPI-U adjustments, potentially increasing payments to ensure supply chain stability. Introduces tailored rules for liquid oxygen, absent in current law.
- Coverage Expansion: Adds respiratory therapist services as a reimbursable Medicare benefit, with add-on payments, expanding beyond physician-only oversight.
- Documentation and Audits: Replaces paper-based or complex records with streamlined electronic templates; reinstates flexible clinical judgment in audits to reduce improper denials.
- Supplier and Patient Obligations: Codifies detailed supplier duties (e.g., education, monitoring) and beneficiary rights (e.g., choice, notices), which were previously guided by regulations but not statutorily mandated.
- Technical Updates: Modernizes outdated language in Medicare definitions for home health services.
Potential Impacts
- On Citizens (Medicare Beneficiaries): Improved access to oxygen therapy, especially portable and liquid options, potentially enhancing quality of life and mobility for those with chronic respiratory conditions (e.g., COPD). Reduced administrative hurdles and stronger protections against supplier issues; clearer cost-sharing info may help avoid unexpected expenses. Monthly notices could prevent copayment surprises after the 36-month rental cap.
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) and contractors face implementation burdens, including rulemaking for payments, templates, criteria, and rights by 2026; electronic processing may streamline claims but require IT updates. Periodic reviews and stakeholder consultations add ongoing administrative costs, though fraud reductions could save money long-term.
- On International Relations: No direct impacts, as the bill focuses on domestic Medicare policy.
Main Stakeholders Affected
- Medicare Beneficiaries: Primary beneficiaries, especially older adults or those with lung diseases needing home oxygen; gain better access, rights, and education.
- Oxygen Suppliers and Manufacturers: Must meet new service standards and electronic documentation; benefit from stable, potentially higher payments outside competitive bidding, but face compliance costs.
- Respiratory Therapists and Healthcare Providers: Expanded reimbursement opportunities; prescribing physicians gain simplified templates but must adhere to clinical criteria.
- CMS and Medicare Administrative Contractors: Responsible for payments, audits, notices, and enforcement; impacts workload and program integrity efforts.
- Patient Advocates and Oversight Groups: Involved in consultations; help ensure beneficiary protections and grievance processes.
Notable Legal, Constitutional, or Political Implications
- Legal Implications: Amends the Social Security Act to clarify Medicare coverage, potentially reducing litigation over denials by restoring clinical judgment and mandating electronic adjudication. Strengthens anti-fraud measures under existing program integrity laws without new penalties. Requires HHS rulemaking, ensuring public input via notice-and-comment processes.
- Constitutional Implications: None apparent; aligns with Congress's authority over federal spending and social welfare programs under the Spending Clause.
- Political Implications: Bipartisan sponsorship (introduced by Republicans and Democrats) signals broad support for improving chronic care access. Addresses stakeholder concerns (e.g., supplier viability, patient rights) amid rising healthcare costs, potentially influencing future Medicare reforms for durable medical equipment. Effective dates (mostly 2026) allow phased implementation to minimize disruptions.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Valadao, David G. [R-CA-22]
Cosponsors (64)
Rep. Brownley, Julia [D-CA-26], Rep. Smith, Adrian [R-NE-3], Rep. Evans, Gabe [R-CO-8], Rep. Vasquez, Gabe [D-NM-2], Rep. Wasserman Schultz, Debbie [D-FL-25], Rep. Ciscomani, Juan [R-AZ-6], Rep. Cohen, Steve [D-TN-9], Rep. Tokuda, Jill N. [D-HI-2], Rep. Davis, Donald G. [D-NC-1], Rep. Dingell, Debbie [D-MI-6], Rep. Lawler, Michael [R-NY-17], Rep. Strickland, Marilyn [D-WA-10], Rep. Houlahan, Chrissy [D-PA-6], Rep. Fields, Cleo [D-LA-6], Rep. Gottheimer, Josh [D-NJ-5], Rep. Harder, Josh [D-CA-9], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Ross, Deborah K. [D-NC-2], Rep. Perez, Marie Gluesenkamp [D-WA-3], Rep. Tlaib, Rashida [D-MI-12], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Sorensen, Eric [D-IL-17], Rep. Smith, Adam [D-WA-9], Rep. Bynum, Janelle S. [D-OR-5], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Mannion, John W. [D-NY-22], Rep. Sewell, Terri A. [D-AL-7], Rep. Craig, Angie [D-MN-2], Rep. Rutherford, John H. [R-FL-5], Rep. Thanedar, Shri [D-MI-13], Rep. Balderson, Troy [R-OH-12], Rep. Olszewski, Johnny [D-MD-2], Rep. Soto, Darren [D-FL-9], Rep. Hayes, Jahana [D-CT-5], Rep. Lofgren, Zoe [D-CA-18], Rep. Cleaver, Emanuel [D-MO-5], Rep. Rogers, Mike D. [R-AL-3], Rep. Adams, Alma S. [D-NC-12], Rep. Moore, Blake D. [R-UT-1], Rep. Dexter, Maxine [D-OR-3], Rep. Kennedy, Timothy M. [D-NY-26], Rep. Riley, Josh [D-NY-19], Rep. Owens, Burgess [R-UT-4], Rep. Bilirakis, Gus M. [R-FL-12], Rep. Figures, Shomari [D-AL-2], Rep. Wilson, Joe [R-SC-2], Rep. Newhouse, Dan [R-WA-4], Rep. Pappas, Chris [D-NH-1], Rep. Bishop, Sanford D. [D-GA-2], Rep. Langworthy, Nicholas A. [R-NY-23] and 14 more
Recent Actions
- 2025-04-10: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-10: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-10: Introduced in House
- 2025-04-10: Introduced in House
Bill Versions
- Supplemental Oxygen Access Reform Act of 2025 — issued 2025-04-10 — PDF (28 pages)