Advanced Wound Care and Regenerative Medicine Access and Reform Act

Key Provisions

• Changes how Medicare would pay for skin substitute products, basing payments on a volume-weighted average of past payment limits, adjusted yearly for inflation, starting January 1, 2026.
• Requires Medicare to pay the same amount for skin substitute products regardless of whether they are applied in a hospital outpatient setting or a doctor's office.
• Requires the government to identify the top 3% of providers who receive the most Medicare payments for skin substitute products and refer them to the government's fraud watchdog.
• Requires Medicare to conduct prepayment reviews of claims for skin substitute products from these identified "outlier" providers starting March 1, 2026.
• Requires Medicare to implement prior authorization for skin substitute products furnished by certain outlier providers starting January 1, 2027.