Healthcare (Medicare)

in committee · United States · Senate Mar 25, 2025

S 1105: No UPCODE Act

S 1105, the No UPCODE Act, changes how Medicare Advantage plans are paid by altering risk adjustment rules. It requires using two years of diagnostic data (starting in 2026) for payment calculations and excludes diagnoses from chart reviews or health risk assessments from those calculations. The bill also mandates that the Medicare program evaluate how coding differences between plans and providers affect payment accuracy and publicly report the findings. These changes directly affect Medicare Advantage plans and their payment rates based on enrollee health status.

Topics ✓ HealthcareSupports HealthcareBill revises Medicare Advantage payment rules to improve accuracy and transparency, protecting program integrity and preventing improper payments.85% confidence

Sub-Topics Medicaid Medicare

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in committee · United States · House Feb 10, 2025

HR 1153: Rural Physician Workforce Production Act of 2025

HR 1153, the Rural Physician Workforce Production Act of 2025, provides additional Medicare payments to hospitals training medical residents in rural areas to address physician shortages. Hospitals can receive payments equal to the difference between rural training costs (based on 2015 GAO data adjusted for inflation) and standard graduate medical education payments, for residents spending at least 8 weeks in rural settings. It specifically supports hospitals with residency programs where over 50% of training occurs in rural locations, regardless of specialty or training site. This bill directly affects eligible hospitals, including critical access and rural emergency hospitals, by incentivizing rural physician training through updated Medicare funding mechanisms.

Topics ✓ HealthcareSupports HealthcareProvides Medicare payments to fund rural residency programs, addressing physician shortages and improving healthcare access in underserved areas.95% confidence

Sub-Topics Hospitals Medicaid Medicare Tags Rural Communities

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in committee · United States · Senate Sep 18, 2025

S 2879: Medicare Advantage Prompt Pay Act

This bill requires Medicare Advantage (MA) plans to pay 95% of complete medical claims within 14 days (for electronic claims) or 30 days (for paper claims) after receipt. If payments are late, MA plans must pay interest at the federal penalty rate and face civil penalties of up to $25,000 per violation. Plans must also publicly report annual data on payment timeliness, including breakdowns for claims under contract versus not under contract with providers. The rules apply to all MA organizations for services provided on or after January 1, 2027.

Topics ✓ HealthcareSupports HealthcareRequires timely Medicare Advantage payments to providers, reducing financial strain and improving healthcare access. Aligns with strengthening payment systems in health coverage.95% confidence

Sub-Topics Medicare

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in committee · United States · Senate Jul 29, 2025

S 2518: Protecting Air Ambulance Services for Americans Act of 2025

Protecting Air Ambulance Services for Americans Act of 2025 This bill authorizes payment changes under Medicare for air ambulance services based on certain collected data and requires additional reporting from providers of these services. Current law requires providers of air ambulance services to report certain information regarding general costs and utilization to the Department of Health and Human Services; private health insurers are also required to report information relating to coverage of these services. The bill authorizes the Centers for Medicare & Medicaid Services to revise payment rates under Medicare for air ambulance services based on this data, and it requires providers of air ambulance services to specifically report information relating to costs and utilization under Medicare. The bill also requires the Government Accountability Office to report on the data that is collected under current law requirements and to recommend changes to Medicare payment rates accordingly.

Topics ✓ HealthcareSupports HealthcareBill modifies Medicare payments for air ambulance services using data and mandates reporting to ensure service stability and access, directly protecting healthcare delivery.90% confidence

Sub-Topics Hospitals Medicaid Medicare

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in committee · United States · Senate Apr 10, 2025

S 1406: SOAR Act of 2025

Supplemental Oxygen Access Reform Act of 2025 or the SOAR Act of 2025 This bill establishes certain requirements with respect to the payment and provision of supplemental oxygen and related services under Medicare. For example, the bill provides for separate payments, indexed to inflation, of oxygen and related equipment, supplies, and services under Medicare (rather than under the competitive acquisition program). It also specifically covers services that are provided by respiratory therapists under Medicare and provides for an additional payment adjustment for these services. Additionally, the bill (1) requires the Centers for Medicare & Medicaid Services to develop an electronic template for providers to use when prescribing oxygen and related equipment, supplies, and services; and (2) establishes certain rights for beneficiaries receiving these items and services, such as the right to choose their suppliers and to receive clear communications and be informed about the services provided.

Topics ✓ HealthcareSupports HealthcareBill establishes separate Medicare payments for supplemental oxygen with inflation indexing, improving access and coverage for beneficiaries, and explicitly covers respiratory therapy services.95% confidence

Sub-Topics Medicaid Medicare

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in committee · United States · Senate Jun 5, 2025

S 1971: Nutrition CARE Act of 2025

The Nutrition CARE Act of 2025 (S 1971) expands Medicare Part B coverage to include medical nutrition therapy for beneficiaries with eating disorders, starting January 1, 2026. It directly affects Medicare beneficiaries diagnosed with eating disorders, including those from historically underserved groups like Black, Indigenous, and People of Color who face significant treatment gaps. The bill amends Medicare law to cover 13 hours of initial medical nutrition therapy (including a 1-hour assessment) and 4 hours annually for ongoing management, provided by registered dietitians or nutrition professionals following a referral from a physician or psychologist. This change addresses a current gap where Medicare did not cover outpatient medical nutrition therapy for eating disorders, aligning coverage with established treatment guidelines.

Topics ✓ Budget & TaxesSupports Budget & TaxesExpands Medicare coverage requiring increased government spending on healthcare services for beneficiaries with eating disorders, aligning with funding essential programs.95% confidence ✓ HealthcareSupports HealthcareExpands Medicare Part B coverage for medical nutrition therapy for eating disorders, directly improving access to mental health services for underserved groups.95% confidence

Sub-Topics Healthcare Workforce Medicare Mental Health

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in committee · United States · Senate Feb 13, 2025

S 575: I CAN Act

The I CAN Act aims to expand healthcare access by removing barriers for nurse practitioners, certified registered nurse anesthetists, and certified nurse-midwives in Medicare and Medicaid programs. Key provisions include allowing nurse practitioners to certify patients for cardiac and pulmonary rehabilitation programs without physician supervision, expanding coverage for services provided by certified nurse-midwives in home health care, and removing unnecessary supervision requirements for nurse anesthetists. The bill changes Medicare rules to permit these advanced practice nurses to provide more services directly to patients in settings like hospitals, skilled nursing facilities, and home health care. This would directly affect millions of Medicare and Medicaid beneficiaries who receive care from these healthcare providers. The changes would take effect 90 days after enactment, with some provisions applying to services furnished on or after that date.

Topics ✓ HealthcareSupports HealthcareRemoves supervision barriers for NPs/CNMs in Medicare/Medicaid, expanding access to cardiac/pulmonary rehab and home health services per bill summary.95% confidence

Sub-Topics Healthcare Workforce Hospitals Medicare

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in committee · United States · House Feb 12, 2026

HR 7546: To amend title XVIII of the Social Security Act to provide coverage for wigs as durable medical equipment under the Medicare program, and for other purposes.

This bill would add wigs (classified as "cranial prostheses") to Medicare's list of covered durable medical equipment. It directly affects Medicare beneficiaries experiencing hair loss due to medical conditions like cancer, chemotherapy, or autoimmune diseases, requiring a written certification from a dermatologist, oncologist, or treating physician. The key provision mandates that coverage only applies when a doctor certifies the medical necessity as part of treatment or rehabilitation. This change modifies existing Medicare rules to include these prostheses under the same coverage criteria as other medically necessary equipment.

Topics ✓ HealthcareSupports HealthcareExpands Medicare coverage for cranial prostheses (wigs) as durable medical equipment, requiring physician certification, directly improving access for beneficiaries with medical hair loss.95% confidence

Sub-Topics Medicare

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in committee · United States · House Feb 3, 2026

HR 7324: More Behavioral Health Providers Act of 2026

This bill expands Medicare incentives to increase mental health and substance use disorder care in underserved areas. It adds a 15% bonus payment to Medicare for specific mental health and substance use services provided by qualified non-physician providers (like clinical social workers, psychologists, and counselors) in designated "mental health professional shortage areas." The bonus applies to services furnished on or after January 1, 2027, directly benefiting Medicare beneficiaries in these areas and encouraging more providers to work there. The change modifies existing Medicare payment rules to include these new provider types and service categories.

Topics ✓ HealthcareSupports HealthcareExpands Medicare incentives for mental health providers in underserved areas, increasing access and funding for behavioral health services through 15% bonus payments.95% confidence

Sub-Topics Healthcare Workforce Medicare Mental Health

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in committee · United States · Senate Jun 2, 2025

S 1925: Expanding Access to Diabetes Self-Management Training Act of 2025

This bill expands Medicare coverage for diabetes self-management training for beneficiaries with diabetes. It requires 100% coverage with no cost-sharing for these services, including an initial 10 hours plus 2 additional hours annually, and allows physicians or qualified non-physician practitioners to authorize them. The bill also establishes a pilot program to test virtual training services starting in 2026, evaluating health outcomes and cost impacts. These changes apply to Medicare beneficiaries with diabetes beginning January 1, 2027.

Topics ✓ HealthcareSupports HealthcareBill expands Medicare coverage for diabetes self-management training with 100% coverage and no cost-sharing, improving patient access and strengthening insurance coverage for beneficiaries.95% confidence ✓ TechnologySupports TechnologyBill establishes pilot program for virtual training services, expanding digital health access and technology integration in Medicare diabetes care.75% confidence

Sub-Topics Medicaid Medicare

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