Healthcare (Medicare)

S 506 establishes a 3-year pilot program to coordinate healthcare between the Department of Veterans Affairs (VA) and Medicare for veterans enrolled in both systems. It assigns case managers to help covered veterans (those using both VA and Medicare) navigate care, reduce gaps in services, and improve outcomes. The program tracks metrics like access, costs, patient satisfaction, and care coordination across 3-5 diverse VA locations. Key provisions include using existing healthcare models, contracting with private entities where possible, and requiring regular reports to Congress on results. The goal is to streamline care for veterans who rely on both VA and Medicare services.

This bill requires the Medicare program to ensure specific electronic reporting methods (like digital clinical quality measures) are available for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program from 2025 through 2029. It clarifies that ACOs won’t be penalized for missing data from certain participants if they meet other reporting rules and demonstrate the participant couldn’t collect data via the required digital method. Additionally, it creates a voluntary pilot program (2028-2032) where selected ACOs report only two quality measures digitally instead of all required measures, with special rules about how this data affects performance scoring. The bill directly affects MSSP ACOs and changes their quality reporting requirements and flexibility.

HRES 694 is a non-binding House resolution calling on the Centers for Medicare & Medicaid Services (CMS) to halt a pilot program using artificial intelligence to decide Medicare coverage for medical services. It directly affects seniors who rely on Medicare, as the resolution argues AI-driven coverage decisions could jeopardize their access to critical healthcare. The resolution expresses the House's "sense" that CMS should not proceed with this AI evaluation method, referencing CMS's June 2025 announcement of the pilot. As a resolution, it does not create new law but urges CMS to pause the program.

This bill requires Medicare to cover genetic testing for inherited cancer risks (like BRCA mutations) for individuals with a family history or suspicious personal history. It also mandates coverage for preventive surgeries (such as mastectomies or hysterectomies) to reduce cancer risk when recommended by clinical guidelines. Additionally, it increases the frequency of evidence-based screenings (like mammograms, colonoscopies, or MRIs) for those with confirmed hereditary cancer mutations, requiring coverage at least annually. These changes apply to Medicare beneficiaries and are based on guidelines from major oncology organizations like the National Comprehensive Cancer Network.

This bill amends Medicare payment rules for long-term care hospitals to ensure they receive full payments for treating seniors in critical condition. It adds a new "high acuity criterion" requiring discharges to be assigned to a specific Medicare payment category (MS-LTC-DRG) with a relative weight of at least 0.8, effective October 1, 2026. Hospitals meeting this criterion for eligible discharges will avoid reduced payments ("site-neutral payments") that would otherwise apply. The change directly affects long-term care hospitals treating Medicare patients with high-acuity conditions and ensures these facilities receive full reimbursement for critical care services.

This bill adjusts Medicare eligibility rules for rural emergency hospitals. It expands eligibility to include off-campus emergency departments that operate as dedicated emergency services in rural counties, meeting specific federal definitions. Hospitals previously classified as outpatient departments could now qualify for Medicare payments if they maintained a dedicated emergency department in a rural area. The change modifies the Social Security Act to allow these facilities to be recognized under the rural emergency hospital designation program. This directly affects rural healthcare providers seeking Medicare reimbursement for emergency services.

HR 3108, the RPM Access Act, increases Medicare reimbursement for remote patient monitoring (RPM) in rural areas by setting a minimum reimbursement floor of 100% for practice expenses and malpractice costs starting in 2026. It requires that RPM services include real-time physician availability to address health issues, use data systems compatible with electronic health records, and mandates providers to report data on cost savings and adherence to medications. The bill directly affects rural Medicare beneficiaries with chronic conditions like heart failure and diabetes, as well as healthcare providers delivering RPM services in underserved rural communities. It also requires a 5-year report to Congress analyzing cost savings from RPM use, including reduced hospitalizations and medication adherence. The law aims to improve access to RPM in rural areas where healthcare shortages are most severe.

This bill amends a federal drug pricing program to better support manufacturers of drugs for rare diseases. It clarifies that time periods when a drug was designated as an "orphan drug" (for rare diseases) will not count toward the timeline for price negotiations under the program. This change directly affects pharmaceutical companies developing treatments for rare conditions by potentially delaying when their drug prices become subject to federal negotiation. The policy adjustment aims to provide more time for these specialized treatments to reach the market without immediate price constraints.

Rural Hospital Closure Relief Act of 2025 This bill temporarily allows additional hospitals to qualify as critical access hospitals (CAHs) that receive special payment under Medicare. Currently, in order to qualify as a CAH under Medicare, a hospital must either (1) be located more than 35 miles (or 15 miles in mountainous regions or areas with only secondary roads) from another hospital, or (2) have been certified prior to January 1, 2006, by the state as a necessary provider of services in the area. The bill allows a hospital to also qualify if the hospital is a small, rural hospital that (1) serves a health professional shortage area, or a high number of low-income individuals or Medicare beneficiaries; (2) has experienced financial losses for two consecutive years; and (3) attests to having a strategic plan to address financial solvency and to committing to provide a service that is in high demand in the hospital's service area. This authority expires nine years after the bill's enactment. The Government Accountability Office must study the effects of the bill's implementation. In addition, the Medicare Payment Advisory Commission must study and recommend payment systems for rural hospitals under Medicare. The Centers for Medicare & Medicaid Services must subsequently establish a mechanism and issue guidance on how newly designated CAHs may transition to different payment models under Medicare, including any new payment models recommended by the commission.

The Personalized Care Act of 2025 expands Health Savings Account (HSA) eligibility to include more types of health coverage, such as health care sharing ministries and certain government programs (like Medicaid, Medicare, and TRICARE). It significantly increases annual HSA contribution limits - from $2,250/$4,500 to $10,800/$29,500 for individuals/families - and allows HSA funds to pay for health plan premiums and medical care service arrangements (like fixed-fee physician contracts). The bill also explicitly treats health care sharing ministry fees as qualified medical expenses, removing barriers for members of these alternative coverage groups. These changes apply to taxable years beginning after December 31, 2025.