Bill > HR6852

This bill, titled the "Advanced Wound Care and Regenerative Medicine Access and Reform Act," aims to improve Medicare coverage and payment for skin substitute products, which are materials applied to wounds to aid healing. It establishes a new payment methodology for these products starting in 2026, based on a volume-weighted average of past Medicare payment limits and adjusted annually for inflation, ensuring consistent payment regardless of where the product is used. The bill also introduces measures to enhance program integrity by identifying and scrutinizing "outlier providers" who receive the highest payments for these products, potentially subjecting them to prepayment claim reviews and prior authorization requirements, and even referral for exclusion from Medicare if billing practices are found to be abusive. Furthermore, it seeks to streamline the approval process for certain human cell and tissue-based products used in regenerative medicine, while maintaining safety and efficacy standards, by reviewing and potentially simplifying application requirements, review timelines, and evidentiary standards.

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https://www.congress.gov/bill/119th-congress/house-bill/6852/all-info