The Right to Override Act (S 2997) requires healthcare facilities and health plans to establish policies allowing healthcare professionals to override AI-driven clinical decision support systems (AI/CDSS) when they believe it's appropriate for patient care or to comply with law. The bill prohibits employers from taking adverse employment actions against healthcare professionals who override AI/CDSS outputs in good faith, and it provides whistleblower protections for those reporting violations of the law. Covered entities must provide training on AI/CDSS usage, establish committees with healthcare professional representation to oversee implementation, and maintain policies that prevent the sharing of override data that could identify specific professionals. Enforcement will be handled by the Department of Health and Human Services for policy violations and the Department of Labor for employment-related violations, with civil penalties up to $769,870 for repeat violations. This bill directly affects healthcare professionals, healthcare facilities, health plans, and other covered entities that use AI/CDSS in clinical settings.
HR 6361, the Ban AI Denials in Medicare Act, prohibits the U.S. Department of Health and Human Services from implementing or testing Medicare models that use artificial intelligence for prior authorization of covered services under traditional Medicare. Specifically, it blocks the existing WISeR model (described in a 2025 federal notice) and prevents future models from using AI to deny coverage for Medicare Part A or Part B services. This bill directly affects Medicare beneficiaries and healthcare providers who would otherwise face AI-driven coverage decisions. The key mechanism is an amendment to the Social Security Act, explicitly banning the use of AI in prior authorization systems within Medicare's innovation models.
The DTC Act of 2025 requires pharmaceutical companies to include a drug's list price (for a 30-day supply) in direct-to-consumer television and digital ads for prescription drugs covered by Medicare or Medicaid. It applies to ads for drugs costing $35 or more per 30-day supply, exempting lower-cost medications. Manufacturers must disclose the list price clearly by July 1, 2026, with penalties of up to $100,000 per violation for noncompliance. The bill aims to provide consumers with upfront pricing information to help them compare costs before filling prescriptions, particularly affecting drugs commonly advertised to Medicare beneficiaries.
This bill would allow faster approval in the U.S. for certain drugs, biologics, and medical devices already approved in specific countries (like Canada or EU nations). Manufacturers could request "reciprocal marketing approval" if the product is legally marketed abroad, meets safety standards, and addresses a U.S. public health need, bypassing the full FDA review process. The FDA must decide within 30 days, and can deny approval for safety concerns or require post-market studies. This directly affects drug/device companies seeking to bring foreign-approved treatments to U.S. patients more quickly.
This bill prohibits Medicare from paying for orthotics and prosthetics delivered via "drop shipment" (direct shipping to patients without proper training from a qualified provider) starting after its enactment. It expands the list of healthcare professionals who can order these devices to include physical therapists, occupational therapists, orthotists, and prosthetists. The bill also ensures Medicare beneficiaries can get covered replacements for custom-fitted orthotics and custom-fabricated orthotic devices. These changes aim to improve patient safety and access to appropriate care by requiring in-person training and clarifying coverage rules. The Secretary of Health and Human Services must issue implementing regulations within one year of the bill's enactment.
The PEERS Act of 2025 requires Medicare to cover peer support services provided by certified specialists at community mental health centers, rural health clinics, and other specified facilities. It directly affects Medicare beneficiaries with mental health or substance use disorders who receive these services, and providers like community mental health centers that will now bill Medicare for this care. The bill defines peer support services as non-clinical assistance focused on recovery, community integration, and self-empowerment, delivered by individuals certified after recovering from similar conditions. Coverage begins January 1, 2027.
This bill amends the Social Security Act to expand Medicare coverage for clinical social worker services. It removes the current restriction limiting these services to "the diagnosis and treatment of mental illnesses," allowing Medicare to cover a broader range of social worker services in healthcare settings. The change applies to services provided on or after December 1, 2025, directly affecting Medicare beneficiaries who receive social work services for non-mental health conditions. This policy adjustment aims to integrate social workers more fully into general healthcare coverage under Medicare.
HRES 619 is a non-binding resolution recognizing the disproportionate mental health challenges faced by minority communities in the U.S. and supporting "Minority Mental Health Awareness Month." It highlights specific disparities, such as higher rates of untreated mental health conditions among Black, Indigenous, Asian American, and Pacific Islander populations due to barriers like stigma, lack of culturally competent care, and systemic inequities. The resolution calls on the President to improve mental health care access that addresses racial, cultural, and social differences in minority communities. It does not create new laws or allocate funds but serves as a symbolic acknowledgment of these health disparities.
This bill authorizes $30 million annually (2026-2030) for expanded research on uterine fibroids at the National Institutes of Health, addressing current underfunding (only $17 million in 2019). It requires the creation of a Medicaid data database to track treatment access and costs for fibroid patients, with a report to Congress within two years. The bill also mandates public education campaigns about fibroid awareness, prevalence (especially among minority women), and non-hysterectomy treatment options. These provisions directly affect women with fibroids - particularly Black women who experience higher incidence, severity, and hospitalization rates - by aiming to improve research, data collection, and patient information.
This bill amends the Affordable Care Act to establish an annual out-of-pocket spending cap for prescription drug cost-sharing under health insurance plans. For 2027, it sets a $2,000 limit for self-only coverage and $4,000 for family coverage (twice the self-only amount). The cap adjusts annually based on premium changes, rounded to the nearest $50 increment. It directly affects ACA planholders with prescription drug coverage, limiting their yearly cost-sharing expenses for medications starting in 2027.
