This bill changes how Medicare pays for certain outpatient services provided by off-campus hospital departments. Starting in 2027, it would allow Medicare to pay for specific services in physician specialties where the total payments for that specialty were under $2 million in the previous year. These services would then be paid under the standard hospital outpatient payment system instead of the usual physician fee schedule. The change directly affects hospitals operating off-campus outpatient departments and physicians in low-volume specialties.
HR 1667, the Acupuncture for Our Seniors Act of 2025, would expand Medicare coverage to include acupuncture services provided by qualified practitioners. It adds "qualified acupuncturist services" to Medicare’s coverage under Section 1861 of the Social Security Act, defining a qualified acupuncturist as a state-licensed practitioner or a physician legally authorized to perform acupuncture. The bill establishes payment rules by including these services in the physician fee schedule and adjusting hospital billing procedures to allow separate billing for acupuncture in inpatient settings. This change would directly affect Medicare beneficiaries receiving acupuncture, as well as acupuncturists and healthcare providers who would now bill Medicare for these services. The provisions would take effect 270 days after the bill’s enactment.
The EASE Act (S 1248) creates a new Medicare and Medicaid model to improve access to specialty health care for beneficiaries in rural or underserved areas. It requires the Centers for Medicare & Medicaid Services to partner with nonprofit provider networks (comprising at least 50 rural clinics or health centers) to deliver specialty care via telehealth and remote technologies, coordinated with primary care providers. Eligible individuals include Medicare Part B beneficiaries or Medicaid/CHIP enrollees living in designated rural or underserved areas. The model mandates that selected provider networks must have proven experience serving rural communities and the capacity to track health data for evaluation.
S 1936 would test a new payment model for Medicare hospice care, allowing blood transfusions to be paid separately from the standard hospice all-inclusive payment. This change would directly affect hospice patients requiring transfusions and Medicare hospice providers, altering how these services are reimbursed. The bill requires the Center for Medicare and Medicaid Innovation (CMI) to establish this model within one year, setting transfusion payments at the standard Medicare rate (not the bundled hospice rate). CMI must then evaluate the model by comparing key metrics like hospital visits, transfusion frequency, and hospice care duration between patients in the new model and similar patients not in the model. The goal is to assess whether separate payment improves access to necessary transfusions without increasing overall costs.
This bill eliminates a lifetime limit on inpatient psychiatric hospital care for Medicare beneficiaries. Currently, Medicare restricts coverage to 190 days total for such care; this bill removes that cap entirely. The key change amends Section 1812 of the Social Security Act to allow unlimited coverage for inpatient psychiatric hospital services under Medicare. The provision takes effect January 1, 2027, directly affecting Medicare patients requiring long-term inpatient mental health treatment.
This bill delays Medicare payment changes for ground ambulance services until 2028 and adds temporary rate increases during a transition period. It directly affects Medicare beneficiaries using ambulance services and ambulance providers who bill Medicare, particularly in rural areas. Key provisions extend the effective date for payment adjustments from October 2025 to January 2028 and establish temporary payment rates: 26.7% for super-rural ambulance services and 4.3% or 3.4% for regular ground ambulance services during the transition period (October 2025-January 2028). These changes aim to prevent sudden payment cuts that could disrupt access to ambulance care.
S 3145, the CARE Act of 2025, creates a new Medicare payment model for ground ambulance services provided during emergencies without patient transport. It directly affects Medicare beneficiaries who receive emergency medical dispatch services (like on-site care) and ambulance providers who serve them. The bill requires Medicare to pay for these non-transport services at rates aligned with traditional transport payments, while allowing telehealth services provided alongside them to count as originating sites. The model will operate for five years, with a mandatory report after four years evaluating its impact on beneficiary access, outcomes, and regional variations in emergency services.
HR 4313, the Hospital Inpatient Services Modernization Act, extends Medicare's waiver allowing acute hospital care at home until 2030 (previously expiring in 2025). It requires the Secretary of Health and Human Services to conduct a detailed study by September 2028 comparing home-based hospital care to traditional inpatient care. The study must analyze quality metrics (like readmission rates and patient outcomes), costs, staffing patterns, and patient demographics - including racial, ethnic, and socioeconomic data - across participating and non-participating hospitals. This bill directly affects Medicare beneficiaries receiving home-based care and hospitals operating under the waiver program.
S 1974 (the ABC-ED Act of 2025) requires hospitals to track real-time emergency department bed capacity and boarding rates using modernized public health data systems, with grant funding to support this. It also creates a Medicare pilot program testing improved emergency care for older adults (through staffing, infrastructure, and geriatric protocols) and for psychiatric crisis patients (via dedicated units and faster transfers to post-acute facilities). The bill mandates a study by the Comptroller General to evaluate best practices for these data systems and their impact on emergency department wait times, boarding rates, and EMS offload times. The study must be completed within one year of enactment and reported to Congress. This bill directly affects hospitals, emergency departments, and post-acute care facilities (like skilled nursing homes) through new data requirements and pilot program participation.
The Critical Access for Veterans Care Act expands veterans' access to critical access hospitals and affiliated rural health clinics by allowing care for veterans living within 35 miles of these facilities without requiring prior authorization or referrals. It establishes that these facilities will be paid at Medicare rates (instead of standard service-based rates) for veteran care, and mandates that claims be processed and paid within 60 days. The bill also requires the Department of Veterans Affairs to submit a report to Congress within one year detailing implementation, claim processing times, and user experience related to this expanded access. This directly affects veterans in rural areas seeking timely healthcare near their homes.
