Healthcare (Medicare)

This bill increases Medicare reimbursement rates for critical access hospitals (CAHs) located in noncontiguous states (like Alaska or Hawaii) to 105% for specific services, up from the current 101%. It directly affects CAHs in these states by raising payments for inpatient care, outpatient services, ambulance transport, and skilled nursing facility services starting January 1, 2026. The key mechanism amends existing Social Security Act provisions to insert the higher 105% rate for services provided by CAHs in noncontiguous states. This policy change aims to address cost disparities for rural healthcare providers in geographically isolated areas.

This bill expands Medicare coverage to include specific home safety items designed to prevent falls, such as grab bars, non-slip mats, shower chairs, and bed rails. It modifies Medicare rules to cover these items without requiring a physician's order and explicitly exempts payments for them from automatic budget cuts under sequestration laws. The policy directly affects Medicare beneficiaries, particularly older adults at risk of falls, by making these safety items more accessible through the program. The changes take effect 60 days after the bill becomes law.

The Medicare Dental, Hearing, and Vision Expansion Act of 2025 would expand Medicare Part B coverage to include dental, hearing, and vision services starting in 2027. This would cover preventive dental services at 100% and other dental services at 80%, hearing aid examinations and hearing aids at 80%, and routine eye exams at 80% with frequency limits (such as two dental cleanings per year). The bill includes $900 million for dental, $370 million for hearing, and $500 million for vision implementation funding, affecting approximately 65 million Medicare beneficiaries who currently pay out-of-pocket for these services.

The Expanding Access to Palliative Care Act (S 1935) creates a new 5-year Medicare model to provide community-based palliative care for beneficiaries with serious illnesses like cancer, heart disease, dementia, or kidney disease. It directly affects Medicare beneficiaries who need symptom management and care coordination, including those who previously used hospice care (who cannot be excluded). The bill requires 24/7 access via telehealth or in-person care, a team-based approach with certified palliative specialists, and aims to reduce unnecessary emergency visits and hospitalizations. Key provisions include eliminating hospice history barriers, requiring care coordination across settings (including homes and hospitals), and measuring outcomes like emergency department use and patient experience.

This bill requires skilled nursing facilities participating in Medicare and Medicaid to permit immediate visitation by any individual designated by a resident, with no restrictions beyond the resident's right to revoke consent at any time. It directly affects nursing home residents (who gain greater control over visitor access) and the facilities themselves (which must comply with this new rule). The key provision adds a specific requirement to both Medicare and Medicaid regulations, mandating that facilities allow access to at least one designated visitor without any additional limitations. The law does not impose new costs or alter facility operations beyond this visitation standard.

The Patient Debt Relief Act (HR 7478) requires Medicare-participating hospitals to implement new financial assistance and debt collection standards starting January 1, 2028. It prohibits hospitals from garnishing wages, placing home liens, or selling medical debt to collectors without offering income-based repayment plans (capping payments at 4% of monthly income) and providing clear eligibility information with bills. Hospitals failing to comply face civil penalties up to $1 million per violation, with annual audits and a public portal for patients to report noncompliance. The bill also creates a $100 million grant program to discharge medical debt for individuals meeting income thresholds (5% of income or household income ≤400% of poverty line). These changes directly affect hospitals and patients burdened by medical debt, aiming to standardize fair collection practices.

HR 6974 amends Medicare accreditation rules for Special Needs Plans (SNPs) serving individuals with disabilities or chronic conditions. Starting in 2026, these plans may use any private accrediting organization approved by the Secretary of Health and Human Services, replacing the current requirement for exclusive NCQA approval. This change directly affects SNP providers who must now meet updated accreditation standards under the new framework. The bill focuses on expanding certification options while maintaining federal oversight through the Secretary’s approval process.

Further Additional Continuing Appropriations and Other Extensions Act, 2025 This bill provides continuing FY2025 appropriations for federal agencies through April 11, 2025. It also extends various expiring programs and authorities, including several public health programs. Specifically, the bill provides continuing FY2025 appropriations to federal agencies through the earlier of April 11, 2025, or the enactment of the applicable appropriations act. It is known as a continuing resolution (CR) and prevents a government shutdown that would otherwise occur if the FY2025 appropriations bills have not been enacted when the existing CR expires on March 14, 2025. The CR funds most programs and activities at the FY2024 levels with some exceptions that provide funding flexibility and additional appropriations for various programs. For example, the CR provides additional emergency funding for the Federal Emergency Management Agency's Disaster Relief Fund, permits the Navy to apportion funds at the rate necessary to fund the Columbia-class submarine program and cost increases for certain shipbuilding programs, and provides additional funding for the Office of Navajo and Hopi Relocation. In addition, the bill extends several expiring programs and authorities, including several public health, Medicare, and Medicaid authorities and programs; authorities related to the Commodity Futures Trading Commission whistleblower program; authorities for the Department of Homeland Security and the Department of Justice to take actions to mitigate a credible threat from an unmanned aircraft system; the special assessment on nonindigent persons or entities convicted of certain offenses involving sexual abuse or human trafficking; and the National Cybersecurity Protection System.

HR 6863, the CAT Act of 2025, requires the Centers for Medicare & Medicaid Services (CMS) to provide Medicare and Medicaid providers with greater transparency and due process when payments are suspended due to fraud allegations. The bill limits payment suspensions to 180 days unless "good cause" is shown, mandates CMS to explain the specific fraud allegations and evidence to providers within 30 days, and requires regular updates during suspensions. It also establishes a new appeals process for providers to challenge suspensions within 180 days of the law's enactment and requires annual reports to Congress on suspension statistics. This directly affects healthcare providers whose payments are suspended, aiming to prevent unnecessary financial harm to those acting in good faith.

This bill, S 2770 (Share the Savings with Seniors Act), changes Medicare Part D drug coverage for seniors taking specific chronic medications. It requires that for covered chronic care drugs (like blood glucose regulators, anticoagulants, and certain inhalers), beneficiaries pay no more than the drug’s actual negotiated price (net price) for costs below the deductible, and coinsurance above the deductible must be based on that net price. The rules apply to plan years starting January 1, 2027, directly affecting Medicare Part D enrollees using drugs in the defined categories. The bill clarifies that cost-sharing for these drugs cannot exceed the negotiated price, aiming to reduce out-of-pocket costs for seniors on long-term medications.