This bill removes geographic restrictions on Medicare telehealth services, allowing rural beneficiaries to receive care at home or remotely starting January 1, 2025. It specifically expands access for critical access hospitals and rural health clinics by standardizing payments for telehealth services and permitting audio-only visits for certain providers like doctors and clinics with established patient relationships. The bill also extends Medicare flexibilities for Federally Qualified Health Centers (FQHCs) and rural health clinics beyond 2024. These changes aim to improve healthcare access in underserved rural communities by removing prior barriers to telehealth.
HR 3387, the No Surprise Bills for New Moms Act, requires health insurance plans and employers to automatically cover newborns for 30 days after birth for any services the plan normally covers, without requiring prior enrollment. This directly affects new parents (including fathers) and their newborns, preventing unexpected bills during the initial post-birth period. The bill also mandates a 60-day special enrollment period to formally add the baby to the plan and requires insurers to notify parents immediately if a claim is filed for an unenrolled newborn. These provisions apply to both employer-sponsored and private health insurance plans.
HR 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.
HR 3227, the Ensuring Seniors’ Access to Quality Care Act, amends Medicare and Medicaid rules to address nurse aide training programs in nursing facilities. It allows the Secretary of Health and Human Services to disapprove a facility’s nurse aide training program for up to two years if the facility received a $10,697+ civil penalty for substandard care and hasn’t corrected the quality issues. Facilities can have disapproval lifted by proving they fixed the care deficiencies, haven’t had recent patient harm incidents, and the penalty didn’t involve immediate patient jeopardy. The changes apply only to penalties assessed after the bill’s enactment and do not affect facilities already prohibited under prior rules.
This bill requires Medicare-participating clinical diagnostic labs to publicly disclose pricing for covered tests starting January 2025. Labs must post three specific prices online: the discounted cash price, minimum negotiated rate with insurers, and maximum negotiated rate for each test, including related services like specimen collection. The information must be updated annually and made accessible on a public website. This directly affects labs that serve Medicare patients, aiming to increase price transparency for consumers and insurers.
The PASTEUR Act establishes a new subscription payment model to incentivize development of new antimicrobial drugs for resistant infections. It creates a Committee on Critical Need Antimicrobials and a Subscription Contract Office to manage payments based on specific drug characteristics like treating multi-drug resistant infections, novel mechanisms of action, and oral administration. Under this model, the government would pay drug developers up to $3 billion over 10 years for qualifying drugs, with payments tied to requirements like ensuring drug availability, reporting resistance data, and developing appropriate use plans. The bill aims to address the lack of new antimicrobial drugs by changing the funding model to reward drugs that meet specific clinical and public health needs.
This bill regulates pharmacy benefit managers (PBMs) working with Medicare Part D prescription drug plans. It prohibits PBMs from earning income based on drug prices or rebates (requiring flat fees instead), mandates equal reimbursement for all network pharmacies, and requires PBMs to report how much of drug rebates they pass through to Medicare plans. The law also mandates annual compliance certifications and requires the government to publish aggregated transparency data (without revealing specific plan details) starting in 2024. These changes directly affect Medicare Part D plans and the seniors who rely on them for prescription drug coverage.
The Pharmacy Benefit Manager Sunshine and Accountability Act requires Pharmacy Benefit Managers (PBMs) to publicly disclose detailed financial information about their contracts with drug manufacturers and health plans. Specifically, PBMs must report total rebates received, administrative fees collected, amounts retained (not passed through to health plans), and the retained rebate percentage for each contract. This data, including the highest and lowest retained rebate percentages across all contracts, must be submitted annually to the Department of Health and Human Services and published on a public website. The bill directly affects PBMs and the health plans/insurance issuers they serve by increasing transparency in how drug pricing and rebates are managed.
HR 2769, the "Stop Penalizing Working Seniors Act," allows seniors over 65 who are enrolled only in Medicare Part A (hospital insurance) to contribute to Health Savings Accounts (HSAs). It removes a current tax rule that barred these seniors from HSA contributions while they remain working. The bill amends the Internal Revenue Code to exclude this group from the existing restriction, effective for taxable years beginning after December 31, 2022. This change directly affects working seniors with limited Medicare coverage who previously could not use HSAs for medical expenses.
HR 2667, the "Fighting Trade Cheats Act of 2023," increases penalties for importers who commit customs fraud or gross negligence. It triples civil penalties for fraudulent violations (to three times the domestic value) and raises gross negligence penalties to ten times, while adding five-year import bans for fraud and two-year bans for gross negligence. The bill also allows U.S. businesses, unions, or trade groups harmed by such violations to sue violators in federal court for triple damages, attorney fees, and injunctions against further imports. Additionally, it excludes violators and their affiliated companies from the Importer of Record program, with special rules to block shell companies evading customs laws. This directly affects importers who violate customs laws and U.S. businesses competing with those imports.
HR 2474, the "Strengthening Medicare for Patients and Providers Act," changes how Medicare pays physicians for services. It replaces the previous two-part payment system (used through 2025) with a single annual payment rate update starting in 2024. This update will be based on the Medicare Economic Index (MEI), which tracks costs for medical providers. The change directly affects Medicare-certified doctors and clinics who receive payments under the physician fee schedule.
This bill would require Medicare to cover FDA-approved blood tests that screen for multiple cancers simultaneously (like breast, lung, or colorectal cancer) for beneficiaries. It directly affects Medicare recipients aged 65+ who could access these new screenings once per year, without prior authorization. The key provision adds "multi-cancer early detection screening tests" to Medicare's covered services under Part B, defining them as blood tests analyzing cell-free DNA, while maintaining existing coverage for standard screenings like mammograms. The bill does not change current coverage for individual cancer screenings but ensures Medicare keeps pace with new medical technology.
