Rep. Mike Kelly

Maddy summaryThis bill expands Medicare Part B coverage to include specific pharmacist services, directly affecting Medicare beneficiaries and pharmacists who provide these services. It adds new coverage for pharmacist evaluations and treatments related to certain illnesses (like COVID-19, flu, or strep throat) and public health emergencies, requiring payment at 80% of the lesser of actual charge or 85% of physician payment rates (100% during emergencies). The bill also prohibits balance billing for these services, ensuring beneficiaries pay only the standard Medicare copayment. These changes aim to improve access to pharmacist care during health crises while aligning payment with existing physician service frameworks.

Maddy summaryThe Emergency Care Improvement Act would permanently allow freestanding emergency centers (FECs) to receive Medicare and Medicaid reimbursement for emergency services. FECs are independently licensed facilities operating 24/7 with on-site physicians, providing emergency care equivalent to hospital-based emergency rooms. The bill sets payment rates for FECs equal to hospital outpatient department rates for higher-level emergency services, based on existing Medicare payment structures. This change would apply to over 110 FECs, mostly in Texas, which previously operated under a temporary pandemic waiver and demonstrated 21.8% cost savings to Medicare for similar care.

Maddy summaryThe HELLPP Act (HR 1634) amends Medicaid to recognize doctors of podiatric medicine (podiatrists) as physicians, enabling them to be reimbursed for services under Medicaid starting January 1, 2024. It also clarifies Medicare’s documentation requirements for therapeutic shoes for people with diabetes, mandating specific written certifications from a managing physician and a podiatrist to confirm medical necessity. These changes directly affect patients with foot conditions, especially those with diabetes, by improving access to podiatrist-provided care and coverage for therapeutic shoes. The bill includes a separate provision strengthening Medicaid program integrity through continuous levies on provider payments, but this does not alter patient coverage. All key provisions take effect on January 1, 2024.

Maddy summaryHR 1610 would modernize Medicare coverage for chiropractic care by removing the current restriction that limited beneficiaries to one chiropractic service per visit. It expands coverage to include all services provided by licensed chiropractors within their state-authorized scope, aligning Medicare with VA, military, and private insurance practices. The bill requires chiropractors to complete a Secretary-approved educational webinar to cover non-spinal services, while still allowing payment for spinal manipulation treatments without this requirement. This directly affects Medicare beneficiaries seeking chiropractic care and chiropractors seeking Medicare reimbursement for their services.

Maddy summaryThis bill requires Medicare and Medicaid to cover prescription digital therapeutics - software-based treatments for medical conditions like diabetes or mental health disorders - starting January 1, 2024. It mandates Medicare to establish payment rates for manufacturers within one year and create specific billing codes within two years, with temporary codes used until permanent codes are set. Manufacturers must report annual data on pricing, usage, and discounts to Medicare, facing penalties of up to $10,000 per day for incomplete or false reports. The bill directly affects Medicare/Medicaid beneficiaries, digital therapeutic companies, and the healthcare billing system by integrating these treatments into federal coverage.

Maddy summaryHR 1407, the Financing Lead Out of Water Act, modifies tax rules to help communities replace lead water pipes. It clarifies that using tax-exempt bonds to replace privately-owned sections of lead service lines connected to public water systems does not count as "private business use" under federal tax law. This change allows public water systems to more easily finance lead pipe replacements through tax-exempt bonds, which are typically restricted from funding private business activities. The bill directly affects public water systems and local governments managing drinking water infrastructure, making it simpler to secure funding for compliance with federal lead regulations.

Maddy summaryThis bill repeals specific provisions from the Affordable Care Act and its 2010 amendment that restricted certain physician referrals to hospitals under Medicare. It directly affects hospitals and physicians who previously faced limitations on referring Medicare patients to facilities they owned or had financial ties with. The key mechanism restores the original rules that allowed such referrals without the prior restrictions, effectively undoing the 2010 changes. This is a procedural change to existing law, not a new policy.

Maddy summaryHR 549, the Metastatic Breast Cancer Access to Care Act, removes waiting periods for disability and Medicare coverage for people diagnosed with metastatic breast cancer. Specifically, it amends Social Security Act sections to allow immediate eligibility for disability insurance benefits (eliminating the standard waiting period) and immediate Medicare coverage (waiving the 24-month waiting period) for these patients. The bill directly affects individuals with metastatic breast cancer who would otherwise face delays in accessing critical benefits. These changes apply to applications filed or benefits beginning after the bill's enactment date. The law makes no other policy changes beyond these specific eligibility adjustments.

Maddy summaryHR 407, the "Protect the UNBORN Act," prohibits federal agencies from implementing or enforcing two specific executive orders issued by President Biden in 2022 (Executive Orders 14076 and 14079), which aimed to protect access to reproductive healthcare services. The bill bans the use of federal funds, including those from the 2022 Consolidated Appropriations Act, to carry out, administer, or enforce these executive orders. It directly affects federal agencies and programs that would otherwise comply with the Biden administration's policies on reproductive healthcare access. The bill does not create new healthcare rules but blocks the implementation of existing executive actions.

Maddy summaryThis bill bans federal funding for abortions in most cases, prohibiting the use of taxpayer money for abortion services or health insurance plans covering abortion. Exceptions allow funding for abortions resulting from rape, incest, or when a pregnancy endangers a woman's life. It requires health insurance plans sold through the Affordable Care Act (ACA) marketplaces to clearly disclose any separate costs for abortion coverage and prohibits ACA subsidies from being used for plans that cover abortion (except in the specified exceptions). The law directly affects federal programs like Medicaid, ACA marketplace plans, and insurers offering health coverage to individuals using federal subsidies.