Rep. Troy Balderson

Maddy summaryThis bill extends Medicare payment adjustments for physicians and other practitioners through 2025 instead of ending in 2024. It specifically adds a 4.73% payment increase for services provided between January 1, 2025, and January 1, 2026. The legislation modifies existing Medicare payment rules to stabilize practice revenues during transition periods. It directly affects doctors and healthcare providers who bill Medicare for patient services. The key change is the extended timeframe and the defined 4.73% rate for the 2025-2026 period.

Maddy summaryHR 9138, the ADAPT Act, expands Medicare coverage to include services provided by psychology trainees (doctoral interns or postdoctoral residents in APA-accredited programs) under the general supervision of a licensed psychologist. It requires the creation of a new billing code (GC modifier) for these services and directs the HHS Secretary to issue guidance to states on covering similar services through Medicaid and CHIP programs. The bill affects psychology trainees seeking licensure and healthcare systems billing Medicare/Medicaid, enabling reimbursement for supervised trainee services. Key provisions include defining "advanced psychology trainee," establishing billing protocols, and providing states with strategies to implement coverage. The changes take effect one year after enactment.

Maddy summaryThis bill creates an exemption from certain physician self-referral rules for specific rural hospitals. It defines a "covered rural hospital" as one located more than 35 miles (or 15 miles in mountainous terrain) from another hospital or critical access hospital, primarily affecting rural facilities in remote areas. The bill also removes restrictions preventing physician-owned hospitals from expanding their services. These changes directly impact rural hospitals meeting the new distance criteria and physicians owning hospitals in those areas, while leaving most existing Medicare self-referral rules unchanged.

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 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 would require the U.S. to reimpose tariffs on steel imports from Mexico that were in effect before May 2019. The tariffs must remain in place for at least one year, and the U.S. Trade Representative and Commerce Secretary must certify that Mexico has fixed its trade practices before lifting them. The President may also add import limits to return steel imports from Mexico to pre-2019 trade levels. The bill directly affects Mexican steel exporters and aims to address claims that Mexico violated a 2019 trade agreement.

Maddy summaryThe EPCS 2.0 Act (HR 7312) requires group health plans and health insurance issuers to implement policies mandating electronic prescriptions for schedule II-V controlled substances by January 1, 2026. The bill includes 18 specific exceptions to this requirement, such as when providers and pharmacies are the same entity, for research protocols, or due to technological limitations preventing electronic transmission. It prohibits requiring specific electronic prescribing vendors and mandates annual compliance attestations from health plans starting in 2026. This legislation applies to prescriptions transmitted by participating providers for health plan members and beneficiaries. The bill aims to modernize prescription practices while maintaining flexibility for healthcare providers and patients.

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 6790 establishes National Institutes of Health centers to advance research, early detection, and public awareness of rare kidney diseases, with a focus on rural and underserved communities. It mandates a federal study on genetic testing barriers, treatment patterns, and public awareness for rare kidney diseases affecting disproportionately impacted populations, including barriers to insurance coverage and access to specialists. The bill also funds nephrology training programs to increase specialists serving these communities and requires experiments to delay or prevent the need for dialysis and transplants. Total funding of $7 million is authorized for fiscal years 2024-2028 to support these research, education, and early intervention efforts.

Maddy summaryHR 6541 directs U.S. Customs and Border Protection to refund duties paid on specific steel and aluminum imports that were retroactively approved for exclusion from additional duties under Section 232 of the Trade Expansion Act. It applies only to steel articles (Harmonized Tariff Schedule 9903.80.01) and aluminum articles (9903.85.01) that received retroactive exclusion approval from the Department of Commerce during 2020-2021. Importers must submit a request within 180 days of the bill’s enactment with details to verify eligibility, and refunds must be issued within 90 days of processing. This bill corrects past overpayments without interest, directly affecting businesses that paid duties on these excluded products.