This bill allows state veterans homes certified by the Department of Veterans Affairs (VA) to be automatically deemed compliant with Medicare’s nursing home standards, eliminating redundant inspections. It requires the VA to provide documentation of inspections, undergo biennial joint reviews with Medicare officials to confirm alignment, and maintain the same care and safety standards as Medicare requires. The bill also mandates that VA inspection data for these homes be publicly reported on the Nursing Home Care Compare website. This applies to all state veterans homes meeting the defined standards, effective 90 days after enactment.
This bill (HR 4345) expands Medicare's definition of "critical access hospitals" to include certain hospitals located on Indian reservations, effective August 1, 2025. It directly affects these reservation hospitals by allowing states to designate them as critical access hospitals without needing to meet the usual distance requirement from other hospitals. Key provisions include waiving the distance rule for reservation facilities and permitting them to establish psychiatric or rehabilitation units without being limited by the standard bed count restrictions. This change aims to improve access to Medicare-covered services for patients at these reservation hospitals.
The PBM Reform Act of 2025 aims to increase transparency and fairness in pharmacy benefit manager (PBM) operations within Medicare Part D and Medicaid programs. The bill requires Medicare Part D plans to allow any pharmacy meeting standard terms to join their networks, establishes "essential retail pharmacies" in underserved areas (with limited pharmacy access), and mandates detailed reporting on drug pricing, rebates, and reimbursement rates. It creates a process for pharmacies to report PBM violations of reasonable contract terms and prohibits "spread pricing" in Medicaid, where PBMs retain the difference between what they pay pharmacies and what they charge plans. These provisions aim to improve pharmacy access for Medicare beneficiaries and ensure fairer reimbursement practices for pharmacies.
HR 4258 would expand Medicare's critical access hospital (CAH) program to include certain hospitals located on Indian reservations. Starting August 1, 2025, states could designate qualifying reservation hospitals as CAHs if they are more than 35 miles (or 15 miles in mountainous areas) from another reservation hospital or an Indian Health Service/tribal facility. This change would allow these hospitals to receive Medicare reimbursement under CAH rules, which provide higher payment rates for rural facilities. The bill also permits such hospitals to establish psychiatric or rehabilitation units without being restricted by the usual bed count limits for CAHs. This directly affects hospitals on tribal lands seeking improved Medicare funding access.
This bill expands Medicare coverage to include genetic counseling services provided by licensed or certified genetic counselors, effective January 1, 2027. It defines "covered genetic counseling services" as those furnished by qualified counselors under state law or certification, with payments set at 80% of the lesser of the actual charge or 85% of the physician fee schedule. Medicare beneficiaries seeking genetic counseling will gain access to these services through covered providers, while preventing balance billing for these specific services. The bill does not restrict physicians from billing for similar services under existing Medicare rules.
Increasing Access to Lung Cancer Screening Act This bill provides for coverage without prior authorization requirements of annual lung cancer screenings under Medicaid, Medicare, and private health insurance for individuals for whom screenings are recommended under U.S. Preventive Services Task Force guidelines. It also expands Medicaid coverage of counseling and pharmacotherapy for cessation of tobacco use to all individuals, rather than only pregnant women. The Department of Health and Human Services must conduct outreach on the importance of lung cancer screenings and who should be screened, and the Government Accountability Office must report on the demographics of those diagnosed with lung cancer and recommend ways the federal government can improve screenings.
This bill allows seniors over 65 who only have Medicare Part A hospital insurance (and no other Medicare coverage) to contribute to Health Savings Accounts (HSAs). Currently, Medicare beneficiaries cannot contribute to HSAs, but this bill removes that restriction for seniors enrolled solely in Part A. The change amends the tax code to exclude these individuals from the existing HSA contribution ban during periods they have only Part A coverage. The provision takes effect for tax years beginning after December 31, 2024.
This bill requires Medicare Advantage (MA) plan advertisements to disclose specific data about prior authorization denials. Starting one year after enactment, ads must include the number of denied prior authorization requests, how many were later approved after reconsideration, and the average time between denial and approval. These disclosures must cover the most recent plan year before the ad is published, using both verbal and visual methods where possible. The policy directly affects MA plan marketers and beneficiaries who view these advertisements, aiming to provide clearer information about plan coverage experiences.
Medicare for All Act This bill establishes a national health insurance program that is administered by the Department of Health and Human Services (HHS). Among other requirements, the program must (1) cover all U.S. residents; (2) provide for automatic enrollment of individuals upon birth or residency in the United States; and (3) cover items and services that are medically necessary or appropriate to maintain health or to diagnose, treat, or rehabilitate a health condition, including hospital services, prescription drugs, mental health and substance abuse treatment, dental and vision services, long-term care, gender affirming care, and reproductive care, including contraception and abortions. The bill prohibits cost-sharing (e.g., deductibles, coinsurance, and copayments) and other charges for covered services. Additionally, private health insurers and employers may only offer coverage that is supplemental to, and not duplicative of, benefits provided under the program. Health insurance exchanges and specified federal health programs terminate upon program implementation. However, the program does not affect coverage provided through the Department of Veterans Affairs or the Indian Health Service. The bill also establishes a series of implementing provisions relating to (1) health care provider participation; (2) HHS administration; and (3) payments and costs, including the requirement that HHS negotiate prices for prescription drugs. Individuals who are age 18 or younger, age 55 or older, or already enrolled in Medicare may enroll in the program starting one year after enactment of this bill; other individuals may buy into the program at this time. The program must be fully implemented two years after enactment.
This bill adds specific Medicare coverage for treatments of dialysis-related amyloidosis, a condition affecting some long-term dialysis patients. It defines these treatments as FDA-approved items/services provided in dialysis facilities, including necessary adjunct supplies. Medicare will pay 100% of reasonable charges for these treatments separately, outside standard dialysis payment bundles. This directly affects Medicare beneficiaries receiving these specific treatments at approved dialysis facilities.
