Rep. John Joyce

Maddy summaryThis bill temporarily caps Medicare payments for high-cost long-term care hospital patients, limiting fixed loss amounts to $50,000 for fiscal years 2025 and 2026. It also creates a temporary exception (2025-2027) allowing standard Medicare payments for patients with severe wounds (like stage 3/4 wounds, infections, or osteomyelitis) instead of site-neutral rates. The bill requires two studies: one on reforming high-cost outlier payment methodology and another analyzing whether the severe wound payment exception should become permanent. These changes directly affect long-term care hospitals treating Medicare beneficiaries with high resource needs or severe wounds. The studies will inform future policy decisions but do not alter current payment rules beyond the specified temporary periods.

Maddy summaryThis bill establishes a process for Medicare to set payment rates for certain pediatric medical devices used in children's care. Manufacturers of qualifying pediatric technologies (devices approved by the FDA, covered under Medicare, and designed specifically for children or used predominantly in pediatric procedures) can request the Secretary to create national payment rates under the physician fee schedule. The Secretary must then set these rates using available data like claims or pricing information, with specific deadlines for processing requests (by May 1 for same-year implementation). This affects Medicare payments for these devices but does not change coverage requirements or guarantee payment for new technologies.

Maddy summaryHR 9125, the Patient Access to LTCH Care Act, adjusts Medicare payments for long-term care hospitals (LTCHs) treating patients with complex medical conditions. It increases payment rates by 5% or 10% for LTCHs based on the number of major complications or comorbidities a patient has, with specific thresholds tied to Medicare coding. The bill also sets annual caps on payment increases ($50,000 for 2025-2026, 110% of prior year for later years) and creates exceptions to ensure patients with severe wounds, specific diagnoses (like septicemia or pulmonary issues), or post-COVID care receive appropriate coverage. This directly affects LTCHs and Medicare beneficiaries with high-acuity conditions requiring specialized care.

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 ROCR Value Based Program Act establishes a new Medicare payment system for radiation oncology services, replacing the current fee-for-service model with a per-episode payment structure. This program affects radiation therapy providers (hospital outpatient departments) and suppliers (physician practices or freestanding centers) treating Medicare beneficiaries with specific cancer types (including breast, prostate, lung, and brain metastases). Key provisions include 80% of the payment being paid upfront within 30 days of treatment start, with the remaining 20% paid later; a health equity add-on payment of $500 per patient for transportation services to patients reporting transportation insecurity (using ICD-10 code Z59.82); and quality incentives for accredited providers through a 0.5% payment increase for meeting accreditation requirements. The program aims to stabilize payments, improve access to radiation therapy, enhance quality, leverage technology, and contain costs while maintaining Medicare savings.

Maddy summaryThe Responsible Use of Seafloor Resources Act of 2024 directs the President to coordinate federal agencies in supporting U.S. development of seafloor nodule collection and domestic processing for critical minerals used in defense and clean energy. It mandates annual reports analyzing the environmental, social, and economic impacts of seafloor minerals compared to land-based mining, including job creation and ecosystem effects. The reports will assess how U.S. sourcing aligns with security goals and international standards, while tracking benefits like supply chain diversification and reduced reliance on foreign sources.

Maddy summaryHR 7427 clarifies that states may use Temporary Assistance for Needy Families (TANF) funds to support pregnancy centers and other "alternatives to abortion" programs that provide life-affirming services like counseling, parenting resources, and material support to pregnant individuals. The bill explicitly defines these programs as those promoting childbirth over abortion through services such as prenatal care coordination, job training, infant supplies, and adoption referrals, while excluding entities that provide or facilitate abortions. It also prohibits federal discrimination against grantees or states that fund such programs, including preventing the government from imposing unfair requirements or cutting funding based on a provider's opposition to abortion. This bill directly affects pregnancy centers, adoption agencies, and maternity homes receiving TANF funding, ensuring their eligibility under existing federal law. The legislation responds to a 2023 federal proposal that threatened to restrict such funding.

Maddy summaryThis bill amends Medicare eligibility rules to explicitly include occupational therapy as a qualifying service for home health care. It changes the Social Security Act to state that beneficiaries need "occupational, or speech therapy" (instead of only "speech therapy") to qualify for home health services. This change directly affects Medicare beneficiaries requiring occupational therapy at home, expanding access to this specific care. The policy takes effect for services provided on or after January 1, 2025.

Maddy summaryThis bill, HR 6860, protects patients with end-stage kidney disease (ESRD) who require dialysis by preventing health insurance plans from discriminating against them. It amends Medicare rules to prohibit plans from treating dialysis coverage differently than other medical services based on a patient’s ESRD diagnosis, need for dialysis, or any other factor. The bill clarifies that plans can still choose which dialysis providers to include in their networks but cannot deny or limit coverage for dialysis services solely because of the patient’s condition. It ensures Medicare remains the secondary payer for these services as intended, without forcing plans to cover specific providers.

Maddy summaryThe Preserving Seniors’ Access to Physicians Act of 2023 increases the Medicare payment adjustment rate for physicians from 1.25% to 4.62%, directly affecting doctors who treat Medicare patients (primarily seniors). It also reduces the funding for the Medicaid improvement fund from $5,796,117,810 to $3,973,117,810. These changes impact Medicare providers and Medicaid programs, with the Medicare adjustment aimed at supporting physicians adjusting to payment changes. The bill does not specify how the Medicaid funding reduction relates to its stated goal of preserving seniors' access to physicians.