SOAR Act of 2025
- Bill Number
- S. 1406
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-04-10: Read twice and referred to the Committee on Finance.
- Last Updated
- 2026-06-16T15:01:22Z
AI-Generated Summary
Purpose of the Legislation
The Supplemental Oxygen Access Reform Act of 2025 (SOAR Act) aims to update Medicare's coverage and payment rules for supplemental oxygen therapy provided in the home and community. It seeks to make payments fairer for suppliers, improve access for Medicare beneficiaries who need oxygen due to conditions like chronic lung disease, reduce administrative burdens, strengthen protections against fraud, and establish clear rights for patients.
Key Provisions
- Reform of Medicare Oxygen Benefits (Title I):
- Excludes oxygen and related equipment, supplies, and services (e.g., tanks, concentrators, portable units) from Medicare's competitive bidding program starting January 1, 2026, to simplify access.
- Sets new payment rates: In competitive bidding areas, payments start at 2025 fee schedule levels and adjust annually with the Consumer Price Index (CPI) for urban consumers. Rural and remote areas (e.g., Alaska, Hawaii) get a blend of national averages and fee schedules, also CPI-adjusted.
- Special rules for liquid oxygen: Establishes a separate payment at least 200% of 2015 rates (CPI-updated), with add-ons for high-flow needs (≥6 liters per minute) and periodic reviews every three years. Includes transitional payments until full implementation and objective coverage criteria updated every five years.
- Defines supplier duties, such as initial evaluations, patient education on safety, timely delivery/setup, 24-hour support, and coordination for travel or relocation.
- Makes technical updates to Medicare definitions for clarity.
- Reimbursement for Respiratory Therapists (Title II):
- Adds respiratory therapist services (e.g., assessment, treatment, monitoring for oxygen needs) as a covered Medicare benefit starting January 1, 2026, defined by state laws.
- Requires a non-budget-neutral add-on payment to oxygen suppliers for including respiratory therapists, determined through public input.
- Strengthening Program Integrity (Title III):
- Mandates electronic templates for doctors to document medical necessity (e.g., blood gas tests, patient exams) for oxygen claims starting January 1, 2026, without needing full medical records.
- Restores "clinical inference" in audits, allowing reviewers to use medical judgment like pre-2009 practices, to avoid overly strict denials.
- Requires annual notices to beneficiaries about oxygen rental periods (36 months), cost-sharing (copays end after rental or if therapy stops), and grievance options. Monthly notices track remaining copay months.
- Beneficiary Rights and Protections (Title IV):
- Establishes patient rights, including choosing/changing suppliers, clear communication, privacy of health info, info on treatment options/refusals, financial responsibilities, timely repairs/replacements, travel assistance, emergency plans, and grievance filing without retaliation.
- For involuntary discharge by suppliers, requires 30-day written notice (or shorter for safety risks) and proper procedures.
Significant Changes to Existing Law
- Payment System Overhaul: Shifts oxygen from competitive bidding (which sets prices via supplier auctions) to a fee schedule-based model with CPI updates, potentially increasing payments to match costs better. Liquid oxygen gets dedicated, higher payments to address its unique delivery challenges (e.g., storage, transport regulations).
- Coverage Expansion: Adds respiratory therapist services as reimbursable, previously not explicitly covered under Medicare Part B.
- Documentation and Audits: Replaces paper-based or complex proof with simple electronic templates; reinstates flexible clinical judgment in reviews to reduce claim denials.
- Notices and Rights: Introduces mandatory beneficiary notifications and a bill of rights, absent in prior law, to enhance transparency and prevent disputes.
- Effective dates vary: Most changes start January 1, 2026; supplier duties and rights take effect one year after enactment.
Potential Impacts
- On Citizens (Medicare Beneficiaries): Improved access to oxygen therapy, especially portable and liquid options, for better mobility and quality of life. Reduced barriers like claim denials or supplier shortages; clearer info on costs (e.g., 36-month rental cap with copays up to 80% after deductible) and rights could lower out-of-pocket surprises and empower patients.
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) must develop new payment rules, templates, and criteria via public rulemaking, increasing short-term administrative workload but potentially cutting long-term fraud costs through electronic processes. Medicare contractors will handle more streamlined claims adjudication.
- On Suppliers and Providers: Higher, cost-reflective payments may encourage more suppliers to participate, especially in rural areas, but add requirements for education, monitoring, and 24-hour support.
- International Relations: No direct impact, as this is a domestic Medicare reform.
Main Stakeholders Affected
- Medicare Beneficiaries: Primarily older adults or those with respiratory conditions (e.g., COPD) relying on home oxygen; gains access and protections but may see stable or slightly higher program costs passed indirectly.
- Oxygen Suppliers and Manufacturers: Face new duties and electronic reporting but benefit from exclusion from bidding and adjusted payments to cover costs like delivery and maintenance.
- Respiratory Therapists and Physicians: Therapists get reimbursement for oxygen-related care; doctors use simpler templates for prescriptions, with more clinical flexibility in audits.
- CMS and Medicare Contractors: Responsible for implementation, oversight, and fraud prevention.
- Patient Advocates and Caregivers: Involved in consultations; help ensure beneficiary-focused rules.
Notable Legal, Constitutional, or Political Implications
- Legal: Amends the Social Security Act (Medicare Part B) to align payments with real costs, potentially reducing litigation over claim denials by restoring pre-2009 audit flexibility. Requires CMS regulations for implementation, ensuring compliance with federal rulemaking (e.g., notice-and-comment). Strengthens anti-fraud measures without overly burdening providers, per Medicare integrity laws.
- Constitutional: No apparent issues; supports equal access to healthcare under the Spending Clause, without infringing on free speech, due process, or other rights.
- Political: Bipartisan sponsorship (Sens. Cassidy, Klobuchar, Warner) highlights consensus on vulnerable population support. Could influence broader durable medical equipment reforms, emphasizing patient-centered care amid rising chronic disease costs, but may face debate over non-budget-neutral add-ons increasing Medicare spending.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (7)
Sen. Klobuchar, Amy [D-MN], Sen. Warner, Mark R. [D-VA], Sen. Moran, Jerry [R-KS], Sen. Blackburn, Marsha [R-TN], Sen. Capito, Shelley Moore [R-WV], Sen. Marshall, Roger [R-KS], Sen. Boozman, John [R-AR]
Recent Actions
- 2025-04-10: Read twice and referred to the Committee on Finance.
- 2025-04-10: Introduced in Senate
Bill Versions
- Supplemental Oxygen Access Reform Act of 2025 — issued 2025-04-10 — PDF (28 pages)