How S 3258 changes current law

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill adds new provisions to cover ALS-related services under Medicare for individuals diagnosed with amyotrophic lateral sclerosis.

• Part E of title XVIII of the Social Security Act

  In the case of a covered ALS individual, the Secretary shall establish a supplemental facility-based payment system described in subsection (d) for ALS-related services provided to such an individual.

  Adds a new section for Medicare coverage of ALS-related services.

• Part E of title XVIII of the Social Security Act

  For purposes of this section, the term `covered ALS individual' means an individual who is medically determined to have amyotrophic lateral sclerosis (as described in section 226(h)).

  Defines 'covered ALS individual' for new payment provisions.

• Part E of title XVIII of the Social Security Act

  For purposes of this section, the term `ALS-related services' means items and services that are furnished to a covered ALS individual in an outpatient setting by a qualified provider.

  Defines 'ALS-related services' under the new section.

• Part E of title XVIII of the Social Security Act

  The Secretary shall establish a payment system under which a single payment determined in accordance with the succeeding paragraphs is made to a qualified provider for ALS-related services furnished to a covered ALS individual.

  Creates a payment system specifically for ALS-related services.

• Part E of title XVIII of the Social Security Act

  For coverage year 2025, the Secretary shall establish a single payment amount for ALS-related services equal to $800 for such services furnished for each visit during such year.

  Establishes a specific payment amount for ALS-related services starting in 2025.

• Part E of title XVIII of the Social Security Act

  For coverage year 2026, the Secretary shall establish a single payment amount for ALS-related services furnished for each visit during such year that is the greater of the payment amount recommended by the Comptroller General or the amount specified for 2025.

  Sets a minimum payment for ALS-related services for 2026, ensuring it reflects the prior year or recommendations.

• Part E of title XVIII of the Social Security Act

  For each coverage year beginning with coverage year 2027, the Secretary shall annually increase the payment amount for each visit based on an ALS services market basket percentage increase.

  Mandates annual increases for ALS service payments to keep pace with market conditions.

• Part E of title XVIII of the Social Security Act

  For each coverage year beginning with coverage year 2028, and every 3 coverage years thereafter, the Secretary shall reestablish a single payment amount for ALS-related services.

  Requires periodic re-evaluation of payment amounts for ALS services every three years.

• Part E of title XVIII of the Social Security Act

  The payment system under this subsection shall include a payment adjustment for a qualified provider that is participating in at least 1 clinical trial identified on the clinicaltrials.gov database.

  Introduces payment adjustments to incentivize participation in clinical trials.

• Part E of title XVIII of the Social Security Act

  Payment under this subsection shall be made only on an assignment-related basis without any cost sharing.

  Ensures that ALS-related services have no cost-sharing for recipients.

• Part E of title XVIII of the Social Security Act

  The term `qualified provider' means a provider of services or a clinic which is capable of furnishing care to a covered ALS individual.

  Defines what constitutes a 'qualified provider' for ALS services.