Rep. Adrian Smith

Maddy summaryThe PEERS Act of 2023 (HR 6748) would add Medicare coverage for "peer support services" starting January 1, 2025. These services, provided by certified specialists who have recovered from mental health or substance use conditions, offer emotional, informational, and community support to Medicare beneficiaries diagnosed with mental disorders or substance use disorders. The bill establishes payment rates (80% of a fee schedule) for community mental health centers and certified community behavioral health clinics offering these services and modifies Medicare exclusions to allow coverage. It directly affects Medicare beneficiaries with these diagnoses, certified peer support specialists, and eligible healthcare providers like Federally Qualified Health Centers.

Maddy summaryThe Strengthening Innovation in Medicare and Medicaid Act (HR 6732) establishes new rules for how the Center for Medicare and Medicaid Innovation (CMI) tests healthcare payment and service delivery models. It limits Phase 1 model testing to 5 years and 500,000 beneficiaries or 10% of applicable individuals, caps new Phase 1 models at six per fiscal year, and requires continuous monitoring of impacts on beneficiaries' access to care and health outcomes. The bill mandates public input through 45-day comment periods before model implementation, hardship waivers for providers facing economic challenges, and special consideration for rural and underserved populations. These provisions aim to balance healthcare innovation with patient protection by requiring ongoing evaluation of models' effects on quality of care, health disparities, and access to services.

Maddy summaryThis bill protects religious child welfare providers from losing government contracts or funding if they refuse to provide services conflicting with their sincerely held religious beliefs (e.g., certain foster care or adoption placements). It prohibits states and federal agencies from denying contracts, licenses, or renewals for this reason, and allows providers to sue for violations with recovery of damages and legal fees. States violating the law risk losing 15% of federal child welfare funding. The law applies to all federally funded child welfare services, including foster care, adoption support, and family preservation programs.

Maddy summaryThis bill requires Medicare to use the most recent, accurate data when calculating geographic payment adjustments for physicians, directly affecting doctors who treat Medicare patients. It specifically mandates using current physician wage data instead of non-physician wage data as a proxy, and requires updated office rent or health center expense data for practice cost calculations. The bill also establishes minimum payment floors for 2024 and beyond, preventing budget-neutral reductions in physician reimbursement rates. These changes aim to better reflect current costs for delivering care in different areas.

Maddy summaryThis bill expands Medicare coverage for in-home administration of intravenous immune globulin (IVIG) to include treatment for chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN), effective January 1, 2026. It amends Medicare law to add these conditions to the list of covered primary immune deficiency diseases, directly affecting Medicare beneficiaries with CIDP or MMN who currently lack coverage for in-home IVIG. The bill also allows Medicare payment adjustments based on whether IVIG is used for primary immune deficiency or these new neurological conditions, as determined by the Secretary through formal rulemaking. This creates a specific policy change to broaden access for two neurological conditions previously excluded from in-home IVIG coverage.

Maddy summaryThis bill, HR 5796, prohibits the Department of Health and Human Services from implementing a proposed rule requiring minimum staffing levels in nursing homes. It creates an advisory panel of 15 members - including rural nursing home staff and experts - to study workforce shortages and report on access barriers for seniors, especially in rural areas. The panel must submit an initial report within 60 days, analyzing staffing challenges and recommending solutions to strengthen the nursing home workforce. These provisions directly aim to prevent nursing home closures (like the 129 that occurred in 2022) that threaten rural seniors’ access to care.

Maddy summaryThis bill clarifies that funds from Health Savings Accounts (HSAs) can be used tax-free for qualified long-term care services, as defined by existing tax law. It directly affects HSA account holders who pay for long-term care services like nursing home care or in-home assistance. The key change inserts specific language into the tax code to explicitly include these services under eligible HSA distributions, removing prior ambiguity. The amendment applies to distributions made after the bill's enactment date.

Maddy summaryThe DRA of 2023 adjusts Medicare payment rates for specific durable medical equipment (DME) items that were part of the 2021 competitive bidding program but for which no supplier contracts were finalized. It directly affects DME suppliers and Medicare beneficiaries by establishing a new 2024 payment formula: 90% of the adjusted payment amount plus 10% of the unadjusted fee schedule for eligible items. The bill also extends a temporary transition rule for non-rural areas through December 31, 2024, while delaying a regulatory change until 2025. These provisions aim to stabilize payments for DME items that did not transition to standard pricing under prior rules.

Maddy summaryThe Maintaining Investments in New Innovation Act (HR 5547) extends the exclusivity period for certain advanced drugs from 7 to 11 years. It defines an "advanced drug product" as a drug using genetically targeted technology to change how genes work, such as drugs that suppress or activate gene function. The bill amends the Social Security Act to update the definition of "qualifying single source drug" to include these advanced therapies with the longer exclusivity period. This change directly affects drug manufacturers developing such advanced therapies and influences Medicare's drug coverage rules by delaying generic competition for these specific treatments.

Maddy summaryThis bill clarifies that Medicare must cover external infusion pumps and associated non-self-administrable drugs as durable medical equipment (DME) when specific criteria are met. It directly affects Medicare beneficiaries requiring home infusion therapy for drugs that must be prepared just before use, administered by a healthcare professional, or labeled for external pump use at least monthly. Key provisions require the drug's FDA labeling to specify external pump administration, safe home delivery by qualified suppliers, and preparation/administration requirements. The bill mandates Medicare coverage under existing rules (LCD L33794) for qualifying treatments, effective upon enactment or FDA approval, whichever is later.