Healthcare (Medicare)

in committee · United States · Senate Jan 29, 2026

S 3729: PBM Reporting Transparency Act

The PBM Reporting Transparency Act requires the Medicare Payment Advisory Commission (MedPAC) to produce two reports analyzing pharmacy benefit manager (PBM) agreements with Medicare prescription drug plans. The first report, due 2 years after data becomes available, must detail trends in PBM contracts, their impact on beneficiaries' out-of-pocket costs and pharmacy reimbursement rates, and include recommendations. A second report, due 2 years after the first, will track changes in this data over time and provide updated recommendations. This legislation directly affects Medicare drug plan participants by increasing transparency around PBM practices that influence prescription drug costs.

Topics ✓ HealthcareSupports HealthcareRequires transparency on PBM contracts impacting Medicare drug costs, aiming to reduce beneficiary out-of-pocket expenses and improve cost analysis for healthcare policy.90% confidence

Sub-Topics Medicare Prescription Drugs

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in committee · United States · Senate May 15, 2025

S 1776: Medicare Beneficiary Co-Pay Fairness Act

The Medicare Beneficiary Co-Pay Fairness Act (S 1776) limits out-of-pocket costs for Medicare beneficiaries receiving certain surgical procedures at ambulatory surgical centers. It ensures that coinsurance payments for these services cannot exceed the annual inpatient hospital deductible amount for the same year. If the standard coinsurance would surpass that deductible, the bill requires the Medicare Secretary to cap the beneficiary's payment at the deductible level and reimburse the surgical center for the difference. This change applies to services provided on or after January 1, 2026, directly affecting Medicare beneficiaries undergoing qualifying surgeries.

Topics ✓ HealthcareSupports HealthcareCaps Medicare co-pays for surgical procedures at inpatient deductible level, reducing patient financial burden and improving access to care.95% confidence

Sub-Topics Hospitals Medicare

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in committee · United States · Senate Jul 31, 2025

S 2561: Skin Substitute Access and Payment Reform Act of 2025

This bill reforms how Medicare pays for skin substitute products used to treat chronic wounds like diabetic foot ulcers. It establishes a new payment system based on a volume-weighted average of historical prices for all covered skin substitutes (excluding temporary dressings or certain other products), effective January 2026. This replaces current pricing that varied by product type and incentivized expensive options, aiming to contain costs while ensuring all clinically similar products are covered equally. The reform directly affects Medicare beneficiaries requiring wound care, healthcare providers selecting treatments, and Medicare's payment system for these products.

Topics ✓ HealthcareSupports HealthcareReforms Medicare payment for skin substitutes to contain costs while maintaining access to clinically similar products, supporting patient access to necessary treatments.90% confidence

Sub-Topics Medicare

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in committee · United States · Senate May 6, 2025

S 1629: Same Care, Lower Cost Act

This bill establishes "site-neutral" Medicare payments for specific outpatient services starting in 2027, meaning Medicare would pay the same rate regardless of whether care occurs in a hospital outpatient department, ambulatory surgical center, or other approved setting. It directly affects Medicare beneficiaries (older adults and people with disabilities) and healthcare providers by changing how they are reimbursed for approximately 66 identified common procedures like surgeries and diagnostic tests. The key mechanism requires the Medicare Secretary to identify these service categories and set uniform payment rates, while exempting emergency department visits and critical care from this rule. This aims to standardize payments across settings without altering coverage or eligibility for beneficiaries.

Topics ✓ HealthcareSupports HealthcareEstablishes site-neutral Medicare payments to lower costs for beneficiaries and providers, improving cost efficiency in healthcare delivery per bill title and summary.90% confidence

Sub-Topics Hospitals Long-Term Care Medicare

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in committee · United States · House Jun 10, 2025

HR 3884: Telemental Health Care Access Act of 2025

HR 3884, the Telemental Health Care Access Act of 2025, expands Medicare coverage for mental and behavioral health services provided via telehealth. It removes geographic restrictions that previously limited telehealth mental health coverage to rural areas, allowing beneficiaries nationwide to access these services through telehealth. The bill amends the Social Security Act to explicitly include "mental and behavioral health services furnished through telehealth" under Medicare coverage rules. This change directly affects Medicare beneficiaries seeking remote mental health care, making it easier to receive these services regardless of location. The policy change applies to all Medicare Part B beneficiaries using telehealth for qualifying mental or behavioral health services.

Topics ✓ HealthcareSupports HealthcareExpands Medicare coverage for mental health telehealth nationwide, removing rural restrictions and explicitly including mental health services under telehealth coverage.95% confidence

Sub-Topics Medicare Mental Health Telehealth

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in committee · United States · House Jun 3, 2025

HR 3684: Save America’s Rural Hospitals Act

This bill aims to stabilize rural hospitals by modifying Medicare payment policies. It eliminates sequestration for rural hospitals, reverses bad debt reimbursement cuts for critical access hospitals, and permanently extends payment levels for low-volume and Medicare-dependent hospitals. The bill also makes permanent telehealth enhancements for rural health clinics, restores state authority to waive the 35-mile rule for hospital designations, and creates flexibility grants for rural hospitals to transform services. These changes directly affect rural hospitals, critical access hospitals, and Medicare beneficiaries who face significant barriers to accessing care in rural areas. The bill addresses the closure of 151 rural hospitals since 2010 and the vulnerability of 432 more hospitals, aiming to prevent further loss of critical health care access.

Topics ✓ HealthcareSupports HealthcareBill stabilizes rural hospitals via Medicare payment reforms, eliminates funding cuts, and extends telehealth access - directly advancing healthcare access and funding for vulnerable communities.95% confidence ✓ TechnologySupports TechnologyBill expands telehealth enhancements for rural health clinics, improving digital access and technology utilization in healthcare settings.75% confidence

Sub-Topics Hospitals Medicare Telehealth Tags Rural Communities

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in committee · United States · Senate Feb 26, 2025

S 755: Finn Sawyer Access to Cancer Testing Act

This bill requires Medicare, Medicaid, and CHIP to cover cancer diagnostic and laboratory tests (like genetic sequencing for cancer diagnosis and treatment monitoring) for patients. It defines these tests specifically and sets rules: Medicare pays 80% (or 100% for certain cases) of the test cost without deductibles, while Medicaid must cover them starting in 2027 and CHIP must cover them for children and pregnant women starting in 2025. Tests can only be provided once at diagnosis, once for recurrence, and as needed for treatment planning. The bill directly affects cancer patients enrolled in these federal health programs.

Topics ✓ HealthcareSupports HealthcareMandates Medicare/Medicaid/CHIP coverage for cancer diagnostic tests without deductibles, expanding access to critical healthcare services and aligning with coverage expansion indicators.95% confidence

Sub-Topics Children's Health Insurance Medicare

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in committee · United States · Senate Feb 24, 2025

S 683: More Behavioral Health Providers Act of 2025

This bill expands Medicare reimbursement incentives to increase mental health provider access in underserved areas. It adds a 15% bonus payment (up from 10%) for mental health and substance use disorder services provided by specific practitioners in designated mental health professional shortage areas. The key mechanism modifies Medicare's bonus program to include qualified providers like clinical psychologists, social workers, and mental health counselors who treat conditions like depression or addiction. This directly affects these providers by increasing their Medicare reimbursement rates when serving patients in areas with critical shortages of mental health professionals.

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

Sub-Topics Healthcare Workforce Medicare Mental Health

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in committee · United States · Senate Jul 23, 2025

S 2410: Medicaid Bump Act

S 2410, the Medicaid Bump Act, increases federal funding for states that raise spending on Medicaid-covered behavioral health services (including mental health and substance use treatment) above 2019 baseline levels. It provides a 90% federal match for the amount exceeding that baseline, requiring states to use these funds to supplement, not replace, existing state funding for these services. States must also use the funds to improve service delivery, such as through higher provider payments or reducing staff turnover. The bill mandates annual reports to Congress on payment rates, service utilization, and the rationale for payment rates for these services. This directly affects state Medicaid programs and providers delivering behavioral health services.

Topics ✓ Budget & TaxesSupports Budget & TaxesProvides federal 90% match for states increasing Medicaid behavioral health spending above 2019 baseline, requiring state supplement of existing funding to advance public service funding.90% confidence ✓ HealthcareSupports HealthcareIncreases federal funding (90% match) for mental health/substance use treatment services, requires state supplementing (not replacing) existing funding, and mandates improved service delivery.95% confidence

Sub-Topics Medicaid Medicare Mental Health

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in committee · United States · House Jan 12, 2026

HR 7023: Affordable CHOICE Act

The Affordable CHOICE Act (HR 7023) creates a new public health insurance option to be offered exclusively through state health insurance exchanges starting in 2027. It directly affects consumers purchasing coverage through these exchanges by adding a government-run plan that must offer bronze, silver, and gold coverage tiers. Key provisions require the Secretary to set premiums based on geographic rates (using Medicare reimbursement rates if negotiations with providers fail), collect data to reduce health disparities, and establish provider networks using existing Medicare/Medicaid participating providers unless they opt out. The plan must maintain quality and affordability while operating under the same consumer protections as private plans in the exchanges.

Topics ✓ HealthcareSupports HealthcareAdds government-run public health insurance option through state exchanges, expanding coverage choices and access for consumers purchasing through exchanges.95% confidence

Sub-Topics Insurance Medicaid Medicare

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