The Maintaining Innovation and Safe Technologies Act requires the U.S. Department of Health and Human Services to issue Medicare Part B payment guidance by January 1, 2027, for remote monitoring devices that use artificial intelligence. This guidance will clarify payment rules for devices like continuous glucose monitors, which must have an AI component (e.g., automatic adjustments) and transmit patient data to healthcare providers for treatment management. The bill directly affects Medicare coverage for these AI-enabled medical devices, used by patients managing chronic conditions such as diabetes. It does not change current reimbursement rates but mandates clear payment criteria through updated guidance by the specified deadline.
The Safeguarding Medicaid Act (S 1082) requires all Medicaid applicants and recipients in every state and territory to undergo an asset test, removing previous exemptions for people who are aged, blind, or disabled. It sets the resource limit for eligibility at the same level used for Supplemental Security Income (SSI) benefits, meaning individuals with assets above this threshold would be ineligible for Medicaid. The bill also mandates states to implement electronic asset verification systems within one year of enactment and report annually on the number of asset checks conducted during eligibility renewals and new applications. This affects all Medicaid applicants and recipients nationwide, with states required to track and report savings from these verification efforts to the federal government.
This bill requires Medicare to create separate billing codes for ultralightweight manual wheelchairs based on their frame material (e.g., titanium/carbon fiber vs. other materials) starting in 2026. It directly affects Medicare beneficiaries who use these wheelchairs, particularly those purchasing or renting models with titanium or carbon fiber frames. The bill mandates that Medicare pays suppliers the standard rate for such wheelchairs regardless of material, but allows suppliers to charge beneficiaries the difference between that payment and their actual cost. It also requires suppliers to provide clear financial notices to patients before sale or rental to inform them of potential additional costs.
This bill requires drug manufacturers to offer Medicare Part D and Part B patients the lowest price they charge in eight specific countries (Canada, Denmark, France, Germany, Italy, Japan, Switzerland, UK), defined as the "most-favored-nation price." It directly affects drug manufacturers not in a special agreement with Medicare and Medicare beneficiaries who use covered drugs. The model, tested for five years starting in 2029, mandates manufacturers to report pricing data and provide discounts to eligible patients and providers. Manufacturers could avoid the requirement by signing an agreement with Medicare before December 2028. The bill aims to align U.S. drug prices with international averages for certain Medicare-covered drugs.
This bill (HR 2199) prevents private health insurance plans from discriminating against patients with end-stage kidney disease (ESRD) who require dialysis. It amends the Social Security Act to prohibit plans from treating dialysis coverage differently than other medical services or applying network restrictions that disproportionately harm ESRD patients. The law clarifies that plans cannot deny or limit benefits for dialysis based on a patient’s diagnosis, while preserving a plan’s right to choose which dialysis providers are in their network. It directly affects ESRD patients and their private health insurance coverage, ensuring dialysis is treated equally with other covered medical services. The bill does not require plans to include specific dialysis providers but stops them from unfairly restricting access to necessary care.
S 717, the *Increasing Access to Quality Cardiac Rehabilitation Care Act of 2025*, expands Medicare coverage for cardiac and pulmonary rehabilitation programs by broadening which healthcare providers can prescribe these services. The bill amends Medicare rules to allow physician assistants, nurse practitioners, and clinical nurse specialists (in addition to physicians) to prescribe exercise and rehabilitation programs under Medicare Part B. This change directly affects Medicare beneficiaries requiring cardiac or pulmonary rehab, making it easier to access care from a wider range of qualified providers. The key provision removes restrictive language limiting prescriptions to "physicians" and updates definitions to include these additional provider types, effective six months after enactment.
This bill (HR 5467, the PAAT Act) requires Medicare Part D plans to cover specific drugs treating autoimmune diseases, hemophilia, and Von Willebrand disease starting in 2027. It directly affects Medicare beneficiaries with these conditions by mandating plan coverage for relevant medications. Key provisions include requiring plans to include all covered drugs for these conditions and prohibiting prior authorization for such drugs more than once per year, unless the drug is short-term, a controlled substance, or has a risk management strategy. The law aims to reduce coverage barriers for these treatments without altering drug approval or pricing.
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.
The Patients Before Middlemen Act (S 882) improves pharmacy access for Medicare beneficiaries by requiring prescription drug plans to allow any pharmacy meeting standard contract terms to join their networks. It establishes "essential retail pharmacies" in medically underserved areas or regions with limited pharmacy access (such as rural areas with no other pharmacies within 10 miles), and creates standards for reasonable and relevant contract terms between drug plans and pharmacies. The bill also increases transparency requirements for pharmacy benefit managers, mandating detailed annual reports on drug costs, rebates, and pricing practices, with many provisions taking effect for plan years beginning January 1, 2028.
HR 772, the Rural ER Access Act, removes a Medicare rule requiring off-campus emergency departments to be within 35 miles of a main hospital campus. Specifically, it directs the Health and Human Services Secretary to revise Medicare regulations (42 CFR §413.65(e)(3)(i)) to eliminate this location requirement. This change directly affects rural hospitals and healthcare organizations seeking to establish or expand off-campus emergency departments. The key mechanism is updating the Medicare eligibility criteria, allowing such facilities to qualify for billing without the previous geographic restriction, potentially increasing access to emergency care in rural areas.
