Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
This bill amends Medicare payment rules for skin substitute products—cellular, tissue, biological, or synthetic materials applied to wounds and intended to remain in the wound bed. Starting January 1, 2026, Medicare will cover these products and establish a standardized payment rate based on a volume-weighted average of 2023 payment allowances, adjusted annually for inflation. The bill also implements program integrity safeguards, including identification of outlier providers (the top 3 percent by payments), prepayment claim reviews for high-volume providers starting in 2026, and prior authorization requirements beginning in 2027 with $5 million annually through 2030 to administer these reviews. Providers with denial rates exceeding 75 percent over six months can face enrollment revocation or exclusion from Medicare. The legislation protects patient access by requiring that all skin substitute products meet the same coverage criteria in 2026 and prohibiting denials based solely on clinical evidence analysis during that year.
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