Healthcare (Medicare)

Radiation Oncology Case Rate Value Based Program Act of 2025 or the ROCR Value Based Program Act This bill establishes a specialized payment program under Medicare for providers and suppliers of radiation oncology services.  Specifically, the Centers for Medicare & Medicaid Services (CMS) must establish a program under which radiation therapy providers (i.e., hospital outpatient departments) and suppliers (i.e., physician group practices and freestanding radiation therapy centers) receive payments for each episode of care provided to individuals with specified types of cancer. An episode of care  means the period beginning on the day radiation therapy planning is furnished to the individual and ending (1) for individuals with bone or brain metastases, 30 days later; and (2) for individuals with other cancer types, 90 days later. Participation in the program is mandatory for providers and suppliers that participate in Medicare, unless the provider or supplier is part of a state-based Center for Medicare & Medicaid Innovation model or qualifies for a significant hardship exemption. The CMS must set payment rates for the program based on national payment rates with specified adjustments (e.g., geographic adjustments). Providers and suppliers who provide certain transportation services for individuals under their care may receive an additional payment. Providers and suppliers must be accredited in accordance with certain standards, subject to payment reductions. The Government Accountability Office must report on (1) implementation of the program, and (2) underserved areas that are in need of more or newer radiation therapy resources.

This bill requires five major federal agencies (Social Security Administration, Medicare, IRS, VA, and HUD) to certify to Congress before implementing significant changes like staff cuts exceeding 5% in a year or closing over 5% of regional offices. Agencies must prove such changes won’t reduce benefits, delay payments, increase wait times, or weaken outreach for eligible individuals. An Inspector General must study the impact within one year and, if problems are found, require the agency to reverse the changes (e.g., reinstating staff or reopening offices). The law aims to safeguard access to retirement, health, tax, and housing benefits for millions of Americans.

The Old Drugs, New Cures Act creates a new "priority research drug" designation for older medications being studied for new medical uses. It directly affects drug manufacturers who want to investigate existing drugs (approved over 10 years ago) for new indications addressing significant unmet medical needs, particularly for diseases affecting 33%+ of beneficiaries in federal health programs like Medicare, Medicaid, or VA care. Key provisions require the Secretary to designate such drugs within 60 days of a request, then exclude them from Medicaid and Medicare pricing rules that typically treat minor drug modifications as "line extensions." This exclusion allows manufacturers to potentially secure better reimbursement for these repurposed drugs under current program rules. The bill changes how these specific drugs are classified in federal healthcare programs, not the drugs' medical use.

This bill creates a new Medicare buy-in option for eligible retired or disabled first responders aged 50-64. It directly affects qualified law enforcement officers, certain emergency medical personnel, and federal firefighters who have separated from service due to retirement or disability. Key provisions include establishing a premium calculated based on Medicare's average costs, coordinating enrollment periods with the Affordable Care Act marketplace, and ensuring coverage counts as "minimum essential coverage" for tax purposes. The bill also prohibits Medicaid beneficiaries from using this option and requires outreach efforts (2027-2029) to help eligible individuals enroll.

This bill creates a new Medicare payment model (the "Comprehensive Alternative Response for Emergencies Model") that allows Medicare Part B to cover ground ambulance services provided in response to emergency medical calls *without* a full transport. It directly affects Medicare beneficiaries receiving emergency ambulance care and ambulance providers, ensuring they are paid for services like dispatch and initial response that don't include transport. The model requires payment rates to align with standard transport payments, mandates compliance with state protocols, and operates for a 5-year test period. A report by the Comptroller General will evaluate the model's impact on beneficiary access, outcomes, and regional differences after 4 years.

The ABC Act (HR 2491) requires the Centers for Medicare & Medicaid Services and the Social Security Administration to review and simplify eligibility processes, forms, and communications for Medicare, Medicaid, CHIP, and Social Security programs. It specifically aims to reduce duplicate paperwork for family caregivers - defined as individuals supporting people with disabilities or health needs - and improve accessibility through features like ADA-compliant websites, translation services, and reduced call wait times. The agencies must gather input from caregivers and organizations, then implement changes to streamline interactions. Within two years, they must report findings and proposed actions to Congress, with follow-up reports every two years. This procedural bill focuses on administrative improvements, not new benefits.

This bill, HR 2936 (the ABC-ED Act), aims to reduce emergency department crowding by requiring real-time tracking of hospital bed capacity and related metrics like patient wait times. It allows federal grants to modernize public health data systems that monitor emergency department boarding rates, bed availability, and ambulance offload times, with results displayed on a public dashboard (while protecting privacy). The bill also adds two new Medicare Innovation Center pilot programs: one focused on improving care for older adults (through staffing, infrastructure, and senior care coordination) and another for psychiatric crisis care (including dedicated units and faster facility transfers). Finally, it mandates a one-year study by the Government Accountability Office to evaluate best practices for these data systems and their impact on emergency department efficiency.

This bill would expand Medicare to cover dental, vision, and hearing services for beneficiaries 65 and older (and some younger people with disabilities), effective January 1, 2026. It would provide 100% coverage for preventative dental services in 2026, with basic and major dental services gradually increasing to 80% coverage by 2029. Vision benefits would include 80% coverage for annual eye exams and specific limits on eyeglasses, frames, and contact lenses ($100 per year for lenses, $100 every two years for frames, $200 every two years for contacts). Hearing services would include 80% coverage for hearing exams and hearing aids, with a limit of one hearing aid per ear every 48 months. The bill also adds oral health professionals to the United States Preventive Services Task Force to help guide coverage decisions.

This bill expands Medicare coverage to include audiology services provided by qualified audiologists without requiring a physician referral or supervision. Starting January 1, 2027, Medicare will pay 80% of the standard rate for these services, which include hearing and balance assessments and treatment. It specifically allows audiologists to legally provide these services under state law, as long as they are covered if provided by a physician. The bill does not expand the types of services covered beyond those already payable under Medicare as of December 31, 2026.

Supplemental Oxygen Access Reform Act of 2025 or the SOAR Act of 2025 This bill establishes certain requirements with respect to the payment and provision of supplemental oxygen and related services under Medicare. For example, the bill provides for separate payments, indexed to inflation, of oxygen and related equipment, supplies, and services under Medicare (rather than under the competitive acquisition program). It also specifically covers services that are provided by respiratory therapists under Medicare and provides for an additional payment adjustment for these services. Additionally, the bill (1) requires the Centers for Medicare & Medicaid Services to develop an electronic template for providers to use when prescribing oxygen and related equipment, supplies, and services; and (2) establishes certain rights for beneficiaries receiving these items and services, such as the right to choose their suppliers and to receive clear communications and be informed about the services provided.