ALS Better Care Act
Sponsored By: Senator Lisa Murkowski
Introduced
Summary
A new Medicare payment and delivery system for ALS care would create a dedicated category of outpatient ALS-related services and set a per-visit payment to improve access and align reimbursement with ALS care needs.
Show full summary
- People with ALS would gain Medicare coverage for a defined package of outpatient ALS-related services. These services would have no cost sharing.
- Qualified providers would receive a single per-visit payment starting at $800. Future increases would follow an ALS services market basket or Comptroller General recommendations.
- The bill would require rulemaking to define who counts as a qualified provider, require an ICD-10-CM code to trigger payments, and mandate a Comptroller General report every three years starting by January 1, 2027 to guide payment updates. It also directs a rapid report on ALS clinical-trial administration and staffing to identify implementation challenges and possible legislative changes.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 2 benefits, 0 costs, 1 mixed.
Medicare single payment for ALS visits
If enacted, Medicare would pay a single per-visit amount for outpatient ALS care. The payment would be $800 for 2027 and $800 for 2028 unless the Comptroller General recommends a higher amount. From 2029 on the amount would increase by an ALS services market basket percentage each year, except in certain years when the Comptroller General's higher recommendation would apply. You would not have to pay cost-sharing for these ALS outpatient visits. Claims must include an ICD-10-CM code for ALS to get the payment. The Secretary would also allow payment boosts for providers in listed clinical trials and for new, significant services. The Comptroller General must report recommended payments by January 1, 2027 and every three years after.
Medicare coverage for ALS services
If enacted, the bill would define which outpatient items and services count as ALS-related care. Examples include specialized physician or nurse practitioner support, occupational and physical therapy, speech pathology, dietary and respiratory support, registered nurse support, and coordination of durable medical equipment. These services would apply to a "covered ALS individual," meaning someone medically determined to have ALS. ALS-related services would be furnished in an outpatient setting by a qualified provider or under an arrangement made by a qualified provider starting January 1, 2027.
Rules for ALS providers and payments
If enacted, the Secretary would write rules by notice-and-comment to define which providers are "qualified" to furnish ALS-related services and receive the single payment. The Secretary must consult ALS patients, physicians, and ALS organizations when making those rules. The bill would also add qualified ALS providers into Medicare's statutory "arrangements" framework and preserve existing outpatient department supplemental payments for qualifying ALS services in addition to the new single payment. These rule changes could improve clarity and coordination but could also limit which providers qualify and slow implementation.
Sponsors & CoSponsors
Sponsor
Lisa Murkowski
AK • R
Cosponsors
Christopher Coons
DE • D
Sponsored 2/3/2026
Roll Call Votes
No roll call votes available for this bill.
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