Rep. John B. Larson

Maddy summaryThis bill requires Medicare Advantage plans to implement electronic prior authorization systems by 2027 and publish detailed data on their approval and denial rates for medical services by 2026. It directly affects Medicare Advantage plans (private insurers offering Medicare coverage) and their enrollees (seniors 65+), mandating transparency about prior authorization decisions, processing times, and appeal outcomes. Key provisions include requiring plans to report annual statistics on request approvals/denials, average processing times, and use of technology, with this data published publicly by the Centers for Medicare & Medicaid Services. The bill also sets timelines for plan responses to prior authorization requests and mandates reports to Congress on implementation and impacts.

Maddy summaryHR 8390, the Mental Health and MAMA Act of 2024, eliminates cost-sharing (like copays or deductibles) for mental health and substance use disorder services during pregnancy and for one year after birth. It applies to people enrolled in group health plans, individual insurance, or federal employee health plans, covering services provided by in-network providers. The bill requires insurers to waive these costs starting two years after enactment, explicitly including telehealth services. It specifically targets care for pregnant and postpartum individuals, ensuring coverage from pregnancy diagnosis through the 12 months following birth.

Maddy summaryThe Essential Caregivers Act of 2024 requires nursing homes and similar facilities to allow residents to designate essential caregivers who provide emotional support or assistance with daily activities. During emergencies when regular visitation is restricted, facilities must permit at least one essential caregiver access to residents daily and cannot deny access without following specific procedures. Facilities may deny access for a maximum of 7 days during emergencies (or 14 days with state approval), and must provide a written explanation and appeal process if access is denied. The bill establishes a 48-hour appeal process for residents and caregivers to challenge denials, with facilities required to prove violations during appeals. This law applies to Medicare skilled nursing facilities, Medicaid nursing facilities, intermediate care facilities, and certain inpatient rehabilitation facilities.

Maddy summaryThis bill creates a new TANF Program Integrity Unit at the Administration for Children & Families to monitor state use of Temporary Assistance for Needy Families (TANF) funds, with $10 million in annual funding added to support its operations. If a state intentionally misuses TANF funds, the unit would require the state to repay the misused amount by providing direct cash assistance to families earning below 100% of the federal poverty line. The law applies directly to states administering TANF programs, mandating stricter oversight of fund usage and repayment of misused funds. It also requires the unit to submit annual reports to Congress on its activities.

Maddy summaryThe HEAR Act of 2024 would require Medicare to cover hearing rehabilitation services and hearing aids for eligible beneficiaries. It defines hearing rehabilitation to include assessments, counseling, and fitting of hearing aids, while defining hearing aids as FDA-approved devices (excluding over-the-counter options). Coverage applies to Medicare beneficiaries with hearing loss who have not received hearing aids in the past three years and whose hearing has deteriorated, as confirmed by a comprehensive assessment. The bill amends Medicare to include these services as standard benefits, removing prior exclusions that previously limited coverage. This policy change directly affects older adults and people with disabilities who rely on Medicare for hearing care.

Maddy summaryThe SOAR Act of 2024 removes supplemental oxygen and related equipment, supplies, and services from Medicare's competitive bidding program, ensuring direct Medicare payment for these items starting in 2025. It establishes new payment rates for oxygen services, including specific rates for rural areas and liquid oxygen with annual inflation adjustments, and requires oxygen suppliers to provide specific services like initial evaluations, safety education, and 24-hour coverage. The bill also adds respiratory therapist services to Medicare coverage with a new payment add-on, requires electronic templates for documenting medical necessity for oxygen services, and establishes new beneficiary rights including the right to choose suppliers and receive timely equipment repairs. This legislation directly affects Medicare beneficiaries requiring oxygen therapy, oxygen suppliers, and respiratory therapists by changing how these services are paid for and delivered.

Maddy summaryThis bill updates the Supplemental Security Income (SSI) program to better support low-income elderly, blind, and disabled individuals. It raises key financial thresholds: the resource limit for single individuals increases from $2,250 to $20,000 (adjusted annually for inflation), and the general income exclusion rises from $240 to $1,797 per month. The bill also removes a penalty that reduced benefits for married couples, excludes retirement accounts and tribal general welfare payments from resource calculations, and eliminates outdated requirements like dedicated accounts for past-due benefits. These changes directly affect SSI recipients by making it easier to qualify and maintain benefits without losing support due to minor income or resource fluctuations.

Maddy summaryHR 7142 (Alternatives to PAIN Act) requires Medicare Part D plans to cover non-opioid pain management drugs with no deductible and at the lowest copay level starting in 2025. It defines "qualifying non-opioid drugs" as FDA-approved medications that don’t act on opioid receptors (like certain NSAIDs or nerve pain treatments), excluding opioids and schedule I-III drugs. The bill prohibits Medicare plans from forcing patients to try opioids first (step therapy) or requiring prior approval for these non-opioid options. It directly affects Medicare beneficiaries needing pain management, especially those seeking alternatives to opioids for post-surgical or acute pain. The policy change aims to improve access to non-addictive pain treatments while preserving doctors' authority to prescribe medically appropriate care.

Maddy summaryHR 7017 adjusts the calculation for the health care insurance tax credit under the Internal Revenue Code. It allows taxpayers to reduce their tax credit amount by the Medicare premiums paid by household members (including themselves) for Medicare Parts A, B, C, or D, or Medicare supplemental coverage. This change directly affects households where members pay Medicare premiums and qualify for the tax credit. The adjustment applies to coverage months starting after December 31, 2024.

Maddy summaryHR 6063, the Empowering Striking Workers Act of 2023, modifies unemployment insurance rules to provide benefits for workers unable to work due to strikes or lockouts. It directs that unemployment compensation begins 14 days after a strike starts, or earlier if permanent replacements are hired, a lockout begins, or the dispute ends. The bill directly affects workers participating in labor disputes by making them eligible for benefits under these specific conditions, rather than requiring them to meet standard job search requirements. This change is implemented through amendments to the Internal Revenue Code and Social Security Act.