Summary

Removes oxygen equipment and related supplies from Medicare’s competitive acquisition program and creates new Medicare payment rules, supplier responsibilities, and patient protections to improve access to home and community oxygen therapy. It also adds a defined Medicare payment for respiratory therapist services, requires electronic medical-necessity templates for oxygen prescriptions, restores clinical judgment in audits, and mandates notices and consumer rights for oxygen users. Major implementation dates: most changes apply to items and services furnished on or after January 1, 2026, with at least one amendment effective one year after enactment. The Secretary must issue implementing rules and payment rates, and must use notice-and-comment rulemaking and stakeholder consultation for key changes.

Key Points

• Removes supplemental oxygen and related equipment from Medicare’s Competitive Acquisition Program and creates new payment rules for oxygen supplies and services.
• Establishes a defined, non‑budget‑neutral monthly add-on payment for respiratory therapist services beginning for services on/after Jan 1, 2026.
• Requires electronic medical-necessity templates for prescribing practitioners and mandates electronic claims adjudication by contractors.
• Restores allowance for clinical inference and judgment in medical-necessity audits to limit mechanistic denials.
• Creates statutory patient rights and supplier obligations for oxygen users, including choice of supplier, timely repairs/delivery, privacy, and clear notices about rental and cost-sharing.
• Sets a separate payment floor for liquid oxygen and directs the Secretary to publish coverage criteria and supplier responsibilities.
• Imposes new operational requirements on DME suppliers and on CMS contractors and requires notice-and-comment rulemaking with stakeholder consultation.
• Most provisions apply to items and services furnished on or after January 1, 2026; one amendment becomes effective one year after enactment.

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