Rep. Earl L. "Buddy" Carter

Maddy summaryHR 5371, the Choices for Increased Mobility Act of 2023, updates Medicare payment rules for manual wheelchairs. It clarifies that Medicare Part B will not cover the extra cost of titanium or carbon fiber materials in a wheelchair's base, effective January 1, 2023. This specifically affects Medicare beneficiaries who use manual wheelchairs with these materials, as payments will now be calculated without including those component costs. The bill directly changes how Medicare reimburses providers for such wheelchairs by excluding these materials from the standard payment amount. This is a technical adjustment to Medicare's fee schedule, not a new benefit or eligibility change.

Maddy summaryHR 5208, the Health Care Provider Shortage Minimization Act of 2023, clarifies tax treatment for temporary healthcare workers. It amends the tax code to specify that locum tenens physicians and advanced care practitioners (like nurse practitioners or physician assistants) providing services for up to one year at a single site are not treated as employees for tax purposes. This means the workers themselves, the healthcare facilities hiring them, and payors avoid employer tax obligations related to these temporary services. The bill directly affects temporary healthcare providers and facilities seeking to fill staffing gaps without complex employment tax compliance.

Maddy summaryThe Preserving Access to Home Health Act of 2023 repeals a 2018 payment adjustment for Medicare home health agencies, restoring prior payment rates for 2024 and subsequent years. It requires the Medicare Payment Advisory Commission (MedPAC) to analyze how home health agencies' financial performance affects access to care, including reviewing spending and utilization data across Medicare, Medicaid, and other payers. Starting in 2025, the bill mandates home health agencies to report detailed data on visit volumes and payments by payer source (Medicare, Medicaid, private insurers) through updated cost reports. This data will help MedPAC assess payment policy impacts on access to home health services for Medicare beneficiaries.

Maddy summaryHR 5107, the Pandemic Unemployment Fraud Recoupment Act, extends the statute of limitations for enforcing fraud related to pandemic unemployment benefits from 3 years to 10 years across multiple programs, including Pandemic Unemployment Assistance, Federal Pandemic Unemployment Compensation, and Lost Wages Assistance. It requires states to recover overpayments from individuals who knowingly received benefits they weren’t entitled to, through deductions from future unemployment benefits, while maintaining existing due process protections like hearings before repayment. States may waive repayment if the overpayment wasn’t the individual’s fault or if repayment would be unfair. The bill applies directly to individuals who received pandemic-era unemployment benefits through fraudulent means, ensuring states have a longer timeframe to address these cases under established fraud procedures.

Maddy summaryThe Healthy Moms and Babies Act aims to improve maternal and infant health outcomes by enhancing Medicaid and CHIP programs. It requires states to report on maternal health quality measures, creates an option for states to establish "maternity health homes" for coordinated care, and mandates studies on reducing cesarean sections and improving access to doulas. The bill also requires guidance for states on addressing social determinants of health, implementing telehealth for maternal care, and reducing maternal mortality through evidence-based practices. These provisions directly affect pregnant and postpartum women eligible for Medicaid or CHIP, as well as healthcare providers and systems serving them.

Maddy summaryThis bill amends Medicare rules to improve access to home infusion therapy, which delivers IV medications at home for conditions like chronic diseases. It adds pharmacy services (including drug preparation and compounding) to covered Medicare benefits and creates a payment rule: if a supplier isn't physically present during therapy, Medicare pays 50% of the full rate instead of denying payment. It also allows nurse practitioners and physician assistants to establish and review home infusion care plans, previously limited to physicians. These changes, effective January 2024, directly affect Medicare beneficiaries requiring home infusion therapy and providers delivering these services.

Maddy summaryThis bill requires Medicare to cover genetic counseling services provided by licensed genetic counselors at 85% of the physician payment rate. It defines "genetic counselor" as a state-licensed professional (or meeting federal criteria in non-licensing states) and mandates a new billing modifier for these services starting January 1, 2024. Medicare beneficiaries seeking genetic counseling would gain expanded access to these services under this coverage. The policy change applies to services furnished on or after the effective date, with implementation via interim rule.

Maddy summaryThis bill establishes a minimum payment floor for Medicare reimbursements to rural hospitals not located in frontier states. It sets a 0.85 minimum for the area wage index used in hospital inpatient payments (starting October 2023) and a similar floor for outpatient department payments (starting January 2024). This prevents Medicare payments from dropping below 85% of the standard wage index for eligible rural hospitals. The bill includes budget neutrality requirements to ensure overall Medicare payments don't increase, while exempting hospitals already receiving payments above the floor.

Maddy summaryHR 3561, the PATIENT Act of 2023, requires hospitals, health insurance plans, and pharmacy benefit managers to publicly disclose detailed pricing information for healthcare services and drugs. Hospitals must publish standard charges for 300+ shoppable services, including gross charges, payer-specific negotiated rates, and discounted cash prices, with updates required annually. Health plans must provide real-time information on in-network rates, cost sharing, deductibles, and prior authorization requirements for covered services. The bill establishes enforcement mechanisms, including civil monetary penalties for non-compliance, with fines ranging from $300 per day for small hospitals to $5 million for large hospitals that fail to comply with the transparency requirements.

Maddy summaryHR 3285, the Fairness for Patient Medications Act, requires health insurance plans and pharmacy benefit managers to limit patient cost-sharing for "highly rebated drugs" (drugs where manufacturers rebate over 50% of annual spending). Starting January 2025, plans must cap out-of-pocket costs per 30-day supply at 1/12 of the drug’s net price (after rebates), calculated annually. The bill also prohibits hidden discounts from drug manufacturers when plans add previously excluded drugs to coverage, requiring price reductions to be visible at checkout or limited to flat service fees. This directly affects health insurance plans, insurers, and pharmacy benefit managers managing prescription drug coverage.