Healthcare

This bill requires Medicare Advantage plans to implement electronic prior authorization systems by 2028 and report detailed transparency data starting in 2027. Plans must publicly disclose approval/denial rates, average processing times (including for appeals), technology use, and other metrics for covered medical services. It mandates 24-hour response standards for expedited requests and routinely approved services, with data collection to analyze access patterns and potential disparities in rural/low-income communities. These changes directly affect Medicare Advantage plans, providers, and seniors enrolled in these plans by standardizing and increasing visibility into prior authorization processes.

S 652 requires social media influencers and healthcare providers to avoid false or misleading promotions of FDA-approved drugs on social media, including disclosing key safety information like side effects in a summary format similar to traditional drug ads. It makes these individuals liable for civil penalties if they knowingly or recklessly omit critical facts or fail to include required safety summaries. The bill also directs the FDA to issue new guidance on enforcement, monitor drug ads using AI, and conduct market surveillance on social media platforms. This affects influencers, healthcare providers, and drug manufacturers who pay for such promotions, with the FDA authorized to spend $15 million annually for enforcement.

The HEAL-AI Act (HR 6077) establishes a federal grant program to fund medical schools and teaching hospitals in training medical students, residents, and faculty on using artificial intelligence in healthcare. It requires grantees to develop curricula covering AI diagnostics, ethical issues (like bias and patient privacy), and clinical integration, while limiting administrative costs to 10% of funds. Schools must report annually on program progress and publicly share educational materials, with priority given to institutions serving underserved communities. The program allocates $1 million annually from 2026-2030, totaling $5 million over five years, to support competency-based AI literacy in medical education.

This bill requires health insurance plans (including employer-sponsored and individual plans) to cover up to a full year's supply of contraceptives in a single fill, without copays or deductibles. It applies to all contraceptives already covered under existing law, making it easier for insured individuals to access longer-term supplies. The policy change takes effect for plan years beginning January 1, 2026, and mandates government outreach to inform providers and enrollees about the new coverage option.

S 3593, the "Punishing Health Care Fraudsters Act," increases penalties for healthcare fraud committed against federal programs like Medicare and Medicaid. It raises maximum prison sentences under federal law from 10 to 25 years and 20 to 30 years, and boosts fines from $100,000 to $250,000 per violation. The bill also requires the U.S. Sentencing Commission to update guidelines to better reflect the severity of fraud, considering factors like victim harm, financial loss, and privacy violations. This directly affects individuals or entities committing healthcare fraud, aiming to strengthen deterrence through harsher consequences.

This bill requires the Secretary of Health and Human Services to provide education and outreach about existing Medicare coverage for occupational therapy services. Specifically, it mandates that within one year of enactment, the Secretary must clarify how Medicare covers occupational therapy for mental health and substance use disorder treatment using specific HCPCS codes. The bill directly affects Medicare beneficiaries seeking these services and healthcare providers billing under those codes. It does not change coverage rules but ensures stakeholders understand current policy.

Access to Prescription Digital Therapeutics Act of 2025 This bill provides for Medicare and Medicaid coverage of prescription digital therapeutics (i.e., software applications that are used to prevent, manage, or treat medical conditions). The Centers for Medicare & Medicaid Services must establish a Medicare payment methodology for payments to manufacturers that takes into account certain factors (e.g., ongoing use); manufacturers must report specified information about private payors, subject to civil penalties.

The Healthy MOM Act (S 3274) would require health insurance plans to provide a special enrollment period for pregnant individuals beginning when pregnancy is reported to the insurer. It mandates that group health plans cover maternity care for dependents regardless of age, including labor and delivery, and extends Medicaid eligibility during pregnancy and postpartum. The bill requires 12 months of continuous coverage for pregnant and postpartum individuals under Medicaid and CHIP, replacing the current 60-day postpartum coverage period. These provisions aim to improve access to maternity care for women, particularly those from communities disproportionately affected by maternal mortality, such as Black and American Indian/Alaska Native women. The changes would apply to plan years beginning January 1, 2027, with some provisions having earlier effective dates for certain programs.

# Summary of the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2026 This comprehensive appropriations bill allocates funding for the fiscal year 2026 to the Department of Labor, Department of Health and Human Services (HHS), Department of Education, and several related agencies. The bill contains numerous specific funding allocations, restrictions, and procedural requirements. Key elements include: 1. **Major Funding Areas**: - HHS receives significant funding for programs including Medicaid, CHIP, Social Security, and public health initiatives - Education receives substantial funding for student financial assistance, career and technical education, and research - Related agencies receive funding for programs like the Corporation for National and Community Service and the Social Security Administration 2. **Key Restrictions**: - Prohibits using funds for abortions except in cases of rape, incest, or to save a woman's life (Section 506-507) - Bans funding for embryonic research or creation of human embryos for research (Section 508) - Prohibits funding for advocacy of drug legalization (Section 509) - Requires transparency in reporting how federal funds are used (Section 505) - Prohibits using funds for propaganda or political activities (Section 503) 3. **Specific Provisions**: - Requires detailed reporting to Congress about fund usage (Sections 516-517) - Mandates notification to Congress before reprogramming funds (Section 514) - Includes numerous rescission provisions that cancel previously appropriated funds - Contains specific requirements for managing federal contracts and grants - Establishes restrictions on using funds for certain types of research or activities 4. **Notable Funding Amounts**: - $24.6 billion for Student Financial Assistance - $49.4 billion for the Supplemental Security Income Program - $14.7 billion for Social Security Administration administrative expenses - $3.2 billion for Higher Education programs - $2.1 billion for Career, Technical, and Adult Education The bill represents a comprehensive funding package with specific constraints on how funds may be used, reflecting ongoing policy debates about government spending priorities in health, education, and social services.

HR 6739, the Clarity in Professional Degree Act, amends the Higher Education Act to restore federal student aid eligibility for specific professional degree programs that were excluded under a recent Department of Education rule change. It directly affects students pursuing degrees in nursing (ADN, RN, BSN), occupational therapy, physical therapy, social work, accounting, architecture, education specialties, and public health. The bill adds these 10 degree types to the official definition of "professional degree" under federal aid rules, reversing a policy expected to take effect July 1, 2026, which would have removed their aid eligibility. This change ensures students in these critical fields can continue accessing federal loans and grants.