The SOAR Act of 2025 aims to improve Medicare coverage and access to supplemental oxygen therapy, respiratory therapists, and strengthens fraud protection while establishing beneficiary rights.
David Valadao
Representative
CA-22
The SOAR Act of 2025 aims to improve access to supplemental oxygen therapy for Medicare beneficiaries by removing oxygen equipment from competitive bidding programs, establishing fair payment rates, and ensuring access to respiratory therapists. It mandates specific service standards for oxygen suppliers, requires electronic templates for documenting medical necessity to prevent fraud, and restores clinical inference in claim reviews. The act also establishes a series of beneficiary rights, including the right to choose suppliers, receive clear communication, and have faulty equipment repaired or replaced promptly. Finally, the Act requires annual and monthly notices to beneficiaries regarding their benefits and cost-sharing responsibilities.
SOAR Act of 2025 Proposes Overhaul for Medicare Oxygen: New Payment Rules, Therapist Coverage, and Patient Rights Starting 2026
The Supplemental Oxygen Access Reform (SOAR) Act of 2025 aims to significantly change how Medicare handles supplemental oxygen for folks who need it at home. Starting January 1, 2026, this bill pulls oxygen and related gear out of the current competitive bidding system, setting up new payment structures instead. The goal is to stabilize access and potentially improve the services beneficiaries receive, while also bringing respiratory therapists formally into the Medicare payment fold.
Shaking Up the Oxygen Market
Currently, Medicare uses a competitive bidding process in many areas to set prices for things like oxygen equipment. The SOAR Act tosses that system for oxygen starting in 2026 (SEC. 101). Instead, it sets specific payment rates that vary depending on where you live. In areas that had competitive bidding, the 2026 rate will be based on the final 2025 rate, adjusted yearly for inflation. Rural areas get a blended rate, and other areas get a different mix. Why does this matter? Removing competitive bidding could mean more predictable payments for suppliers, potentially leading to more stable service, but it might also mean higher costs for Medicare compared to the bidding system. The bill also specifically calls out liquid oxygen, requiring a separate, higher payment rate (at least 200% of the 2015 base rate, adjusted up) and directing Medicare to set clear clinical rules for who qualifies for it by January 1, 2026. Plus, there's a specific add-on payment planned for patients needing high oxygen flow rates (6+ liters per minute).
More Than Just Equipment: Defining Supplier Duties
This bill isn't just about the money; it's also about the service. Section 102 tasks Medicare with defining exactly what oxygen suppliers must do to get paid. Think of it as a job description for suppliers. This includes evaluating patients properly (using a standard form), making sure they get portable oxygen if needed for mobility (even outside the home), educating patients and caregivers on safe use, delivering and setting up equipment promptly, checking oxygen purity, being available 24/7 for issues, and even helping coordinate services if a patient travels or moves. For someone relying on oxygen, knowing these services are required could provide significant peace of mind.
Bringing in the Experts and Modernizing Paperwork
Big news for respiratory therapists: Section 201 proposes to officially recognize their services under Medicare Part B starting January 1, 2026. This means services like patient assessment, treatment, and monitoring related to oxygen therapy, performed within their state scope of practice, would be covered. The bill also mandates a specific add-on payment for these services, acknowledging their cost. On the administrative side, Section 301 pushes for efficiency and integrity by requiring an electronic template for doctors to document why oxygen is medically necessary. This template aims to streamline the process but notably excludes detailed medical record notes. This section also brings back "clinical inference" for payment audits, meaning auditors can use more professional judgment, similar to how things were done before 2009, rather than relying solely on rigid criteria. This could allow for more nuance in complex cases but might also raise questions about consistency in oversight.
Empowering Patients: Know Your Rights and Costs
Finally, the SOAR Act puts a strong emphasis on patient rights and information. Section 302 requires Medicare to send clearer notices, including annual updates detailing the 36-month oxygen equipment rental period, cost-sharing details (and when they end), and how to file grievances against suppliers without fear of reprisal. Patients will also get monthly updates on how many rental months they have left where they owe a copayment. Furthermore, Title IV establishes a comprehensive list of beneficiary rights (SEC. 401). These rights include choosing your supplier, receiving clear communication, privacy, being informed about treatment options and costs, getting equipment suitable for your mobility needs, timely repairs, help coordinating oxygen when traveling, and a clear process for filing complaints. This aims to ensure patients are active, informed participants in their own care.