Healthcare (Medicare)

in committee · United States · Senate Mar 11, 2025

S 927: Protecting Pharmacies in Medicaid Act

Protecting Pharmacies in Medicaid Act This bill provides funds beginning in FY2026 for the Centers for Medicare & Medicaid Services to survey retail and non-retail pharmacies (e.g., mail-order pharmacies) to determine average prices of covered outpatient drugs under Medicaid. Pharmacies that fail to participate in the surveys are subject to civil penalties. The bill additionally provides funds for FY2026 for the Office of the Inspector General of the Department of Health and Human Services to study the results of the survey and report accordingly to Congress. The bill also requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with pharmacy benefit managers under Medicaid.

Topics ✓ HealthcareSupports HealthcareBill allocates FY2026 funds for Medicaid pharmacy price surveys to determine average drug costs, supporting program integrity and fair reimbursement for participating pharmacies.85% confidence

Sub-Topics Medicaid Medicare Prescription Drugs

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in committee · United States · House Jan 31, 2025

HR 879: Medicare Patient Access and Practice Stabilization Act of 2025

Medicare Patient Access and Practice Stabilization Act of 2025 This bill increases certain payment adjustments under the Medicare physician fee schedule for services furnished between April 1, 2025, and January 1, 2026.

Topics ✓ HealthcareSupports HealthcareIncreases Medicare physician payments to stabilize practices and improve patient access, directly strengthening healthcare funding and access for Medicare beneficiaries.95% confidence

Sub-Topics Medicare

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in committee · United States · House Jun 17, 2025

HR 4037: Occupational Therapy Mental Health Parity Act.

The Occupational Therapy Mental Health Parity Act requires the U.S. Department of Health and Human Services to provide education and outreach about Medicare coverage for occupational therapy services treating mental health and substance use disorders. Specifically, it directs the Secretary to clarify how these services are covered under the Medicare Benefit Policy Manual using standard medical billing codes (HCPCS). This education must be completed within one year of the bill's enactment. The goal is to improve understanding of existing Medicare coverage for occupational therapy in mental health and substance use treatment, without changing current benefit rules.

Topics ✓ HealthcareSupports HealthcareClarifies Medicare coverage for mental health occupational therapy services, improving access and ensuring parity under existing programs.95% confidence

Sub-Topics Medicaid Medicare Mental Health

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in committee · United States · Senate Sep 10, 2025

S 2756: Affordable Inhalers and Nebulizers Act of 2025

This bill, S 2756 (Affordable Inhalers and Nebulizers Act of 2025), sets a $15 monthly cost cap for specified inhaler products used to treat asthma and COPD under private insurance, Medicare Part B, and Medicare Part D plans. It requires insurers to cover these products without deductibles and counts any cost-sharing toward the annual out-of-pocket maximum. The bill also creates a new program to pay for these products for uninsured individuals starting in 2026, with providers agreeing not to bill patients more than $15 per month. It directly affects patients with asthma or COPD who rely on prescribed inhalers or nebulizers, ensuring predictable, low-cost access to these essential treatments.

Topics ✓ HealthcareSupports HealthcareCaps inhaler costs at $15/month under insurance/Medicare, mandates coverage without deductibles, and creates uninsured program - directly improving patient access to essential respiratory treatments.95% confidence

Sub-Topics Medicare Prescription Drugs

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in committee · United States · Senate Feb 12, 2025

S 551: Ensuring Outpatient Quality for Rural States Act

The Ensuring Outpatient Quality for Rural States Act (S 551) adjusts Medicare payments for outpatient hospital services in Alaska and Hawaii to address their higher operating costs. Starting in 2026, it allows the government to modify the non-labor portion of payment rates (covering expenses like rent and equipment) for these states, similar to adjustments made elsewhere. The bill specifies these changes should not be budget neutral, meaning they won’t be offset by cuts to other Medicare payments. It directly affects Medicare-certified hospitals in Alaska and Hawaii providing outpatient care.

Topics ✓ HealthcareSupports HealthcareIncreases Medicare payments for rural outpatient services in Alaska/Hawaii to address higher costs, improving access and quality without budget offsets.95% confidence

Sub-Topics Hospitals Medicare

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in committee · United States · Senate Jan 24, 2025

S 248: Sustainable Cardiopulmonary Rehabilitation Services in the Home Act

This bill makes permanent Medicare coverage for telehealth-based cardiopulmonary rehabilitation services (including cardiac, intensive cardiac, and pulmonary rehab) provided in patients' homes. It removes geographic restrictions for these services after January 1, 2026, allowing Medicare to cover home-based telehealth visits for eligible patients. The law requires the Health Secretary to establish standards for home-based rehab programs by 2026. It directly affects Medicare beneficiaries needing ongoing heart or lung rehabilitation, ensuring they can access these services remotely without location-based limitations. The bill codifies pandemic-era flexibilities into permanent policy for these specific healthcare programs.

Topics ✓ HealthcareSupports HealthcareMakes Medicare coverage permanent for home-based telehealth cardiopulmonary rehab, expanding access and removing geographic restrictions for beneficiaries.95% confidence ✓ TechnologySupports TechnologyBill expands telehealth access for home-based cardiopulmonary rehabilitation, strengthening technology-enabled healthcare delivery and digital health services.85% confidence

Sub-Topics Medicare Telehealth

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in committee · United States · House Apr 3, 2025

HR 2639: Telehealth Access for Tribal Communities Act of 2025

HR 2639, the Telehealth Access for Tribal Communities Act of 2025, permanently expands Medicare telehealth coverage for services provided by Indian health programs and urban Indian organizations. It allows these services to be delivered from any location within the U.S. (including patients' homes) starting April 1, 2025, and includes audio-only telehealth as a covered option. This directly affects tribal communities by removing location restrictions and expanding access to remote healthcare through their existing Indian health programs. The bill modifies Medicare rules to make these telehealth flexibilities permanent, ensuring continued coverage for eligible tribal patients.

Topics ✓ HealthcareSupports HealthcareExpands Medicare telehealth coverage for tribal communities, removes location restrictions, and adds audio-only options to improve healthcare access and service availability.95% confidence ✓ TechnologySupports TechnologyExpands telehealth access via technology, allowing services from any U.S. location including homes, promoting digital equity and internet-based healthcare access.95% confidence

Sub-Topics Medicare Telehealth Tags Tribal Nations

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in committee · United States · Senate May 19, 2025

S 1805: Promoting Access to Diabetic Shoes Act

Promoting Access to Diabetic Shoes Act This bill allows a nurse practitioner or physician assistant to fulfill documentation requirements for coverage, under Medicare, of special shoes for diabetic individuals. Under current law, such requirements may be satisfied only by a physician.

Topics ✓ HealthcareSupports HealthcareBill expands Medicare coverage access by allowing NPs/PAs to certify diabetic shoe prescriptions, removing physician-only barrier and improving patient access to essential medical equipment.90% confidence

Sub-Topics Healthcare Workforce Medicare

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in committee · United States · House Nov 18, 2025

HR 6114: To prohibit funds made available to the Department of Health and Human Services by previous Appropriations Acts from being used for any activity that makes Medicare Advantage the default under the Medicare program.

HR 6114 prohibits using federal funds from previous appropriations to the Department of Health and Human Services for any activity that automatically enrolls Medicare beneficiaries in Medicare Advantage (MA) plans without their active choice. Specifically, it blocks the use of these funds to implement a system where individuals who fail to select a plan are deemed enrolled in MA by default. This directly affects Medicare beneficiaries who might otherwise be automatically enrolled in MA plans without actively choosing them. The bill’s key mechanism is a funding restriction that prevents HHS from using appropriated money to operate this default enrollment process under Medicare Part C. The policy change ensures beneficiaries must actively elect an MA plan to enroll, rather than being enrolled automatically.

Topics ✓ HealthcareSupports HealthcarePrevents automatic Medicare Advantage enrollment, protecting beneficiary choice in coverage options and strengthening patient autonomy within Medicare program.92% confidence

Sub-Topics Medicare

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in committee · United States · House Oct 24, 2025

HR 5821: Rural Hospital Fairness Act

HR 5821, the Rural Hospital Fairness Act, preserves Medicare critical access hospital (CAH) status for specific rural facilities that lost certification due to location changes. It directly affects hospitals designated as CAHs before 2002, certified as of December 31, 2024, and located in counties with no other hospitals at the time of their certification loss. The bill's key provision "deems" these facilities as still certified under Medicare, allowing them to maintain eligibility for CAH funding despite not meeting the standard location requirement. This change prevents certain rural hospitals from losing vital Medicare reimbursement due to geographic shifts in their service area. The policy change applies only to qualifying facilities meeting all other CAH criteria.

Topics ✓ HealthcareSupports HealthcarePreserves Medicare CAH funding for rural hospitals, ensuring continued access to healthcare services in underserved areas by maintaining critical hospital status and eligibility.95% confidence

Sub-Topics Hospitals Medicare Tags Rural Communities

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