H.R. 2902: SOAR Act of 2025

The SOAR Act of 2025 would make a major change on January 1, 2026: oxygen and oxygen-related equipment, supplies, and services would be taken out of Medicare’s competitive acquisition program. In competitive bidding areas, payment in 2026 would be frozen at the fee schedule amount in effect on December 31, 2025, and then rise in later years with the Consumer Price Index for all urban consumers. The bill also creates special formulas for rural and non-contiguous areas — 50% of 110% of the national average price under 42 CFR 414.210(g)(1)(ii) plus 50% of the area fee schedule amount, adjusted annually by CPI — and for other areas, where payment would be 75% of the adjusted competitive bidding area payment plus 25% of the unadjusted fee schedule amount.

The bill pays special attention to liquid oxygen, which many patient advocates say has been underpaid. It sets a payment floor of not less than 200% of the 2015 DMEPOS fee schedule, updated by CPI for 2016 through 2025. It also creates a non-budget neutral add-on for patients using high-flow oxygen at rates of at least 6 liters per minute, calculated as the per-pound cost of oxygen above that 6-liter threshold. If the government has not yet finished the new payment system, a transitional interim payment would kick in from enactment until the new amount is implemented, also set at 200% of the 2015 DMEPOS fee schedule updated by CPI. On top of that, the Secretary must create objective clinical coverage criteria for liquid oxygen by January 1, 2026, and review or update those criteria every 5 years, while also assessing payment adequacy at least every 3 years.

The bill is not only about payment rates. One year after enactment, suppliers would have to meet supplemental oxygen responsibilities criteria to get paid, including 14 specific service obligations such as an initial evaluation using a uniform oxygen patient evaluation form, 24-hour on-call coverage, infection control instructions, monitoring visits that include respiratory therapists when necessary, coordination for beneficiaries who travel, and safety checks for fire and fall risks. Beginning January 1, 2026, Medicare would also add a non-budget neutral monthly payment adjustment for respiratory therapist services, defined as assessment, treatment, and monitoring services performed within the therapist’s scope of practice under State law, regulations, and accreditation standards.

The bill also tightens rules around paperwork and patient rights. Starting January 1, 2026, electronic templates would have to include certification timeframe documentation, blood gas or saturation test results, and proof of need and usage, but the Secretary would be barred from requiring prescribing practitioners to submit medical record notes. For supplier audits, the Secretary would have to use 'clinical inference and clinical judgment' as applied before 2009. Patients would get stronger notices too, including an annual notice explaining the 36-month rental period, cost-sharing, prescription discussion rights, and the grievance process, plus a monthly notice showing how many months remain in the rental cap period. The bill also creates explicit rights for beneficiaries, including choice of supplier, privacy, the right to refuse treatment or experimental research, timely repair or replacement of faulty equipment, and protection against involuntary discharge without 30-day written notice except when there is an immediate threat to health or safety.