Rep. Terri A. Sewell

Maddy summaryThe Prevent Interruptions in Physical Therapy Act of 2023 amends Medicare rules to allow physical therapists to use temporary replacement providers (locum tenens) for outpatient physical therapy services, aligning with existing provisions for physicians. This directly affects Medicare beneficiaries receiving physical therapy and physical therapy practices needing temporary staffing solutions during provider shortages. The bill updates the Social Security Act to extend the current physician locum tenens rule to physical therapists, ensuring continuity of care without requiring separate approval for temporary coverage. It applies to services furnished after the bill's enactment date.

Maddy summaryThe HELLPP Act (HR 1634) amends Medicaid to recognize doctors of podiatric medicine (podiatrists) as physicians, enabling them to be reimbursed for services under Medicaid starting January 1, 2024. It also clarifies Medicare’s documentation requirements for therapeutic shoes for people with diabetes, mandating specific written certifications from a managing physician and a podiatrist to confirm medical necessity. These changes directly affect patients with foot conditions, especially those with diabetes, by improving access to podiatrist-provided care and coverage for therapeutic shoes. The bill includes a separate provision strengthening Medicaid program integrity through continuous levies on provider payments, but this does not alter patient coverage. All key provisions take effect on January 1, 2024.

Maddy summaryHR 1610 would modernize Medicare coverage for chiropractic care by removing the current restriction that limited beneficiaries to one chiropractic service per visit. It expands coverage to include all services provided by licensed chiropractors within their state-authorized scope, aligning Medicare with VA, military, and private insurance practices. The bill requires chiropractors to complete a Secretary-approved educational webinar to cover non-spinal services, while still allowing payment for spinal manipulation treatments without this requirement. This directly affects Medicare beneficiaries seeking chiropractic care and chiropractors seeking Medicare reimbursement for their services.

Maddy summaryThe Critical Access Hospital Relief Act of 2023 removes a Medicare requirement that hospitals needed a physician's certification within 96 hours for inpatient services. This change directly affects critical access hospitals (CAHs), which are typically small, rural facilities serving remote communities. The bill amends Section 1814(a) of the Social Security Act to delete the 96-hour certification rule, effective January 1, 2024. This reduces administrative burden for CAHs by eliminating a specific documentation step for patient admissions. The policy change streamlines Medicare billing processes without altering payment rates or other core hospital services.

Maddy summaryThe Affordable Insulin Now Act (HR 1488) requires health insurance plans and issuers to cover specific insulin products with cost-sharing capped at $35 per 30-day supply or 25% of the negotiated price, whichever is lower, starting in 2024. It directly affects people with diabetes who rely on insulin by limiting out-of-pocket costs for covered products. The bill mandates coverage of all insulin types (rapid-acting, long-acting, etc.) and dosage forms (vials, pumps, etc.) as selected by the plan. This applies to both group and individual health insurance plans under the Public Health Service Act, Internal Revenue Code, and ERISA, with cost-sharing counting toward annual deductibles.

Maddy summaryThis bill expands Medicare coverage for hereditary cancer prevention and management. It requires Medicare to cover genetic testing for individuals with a personal or family history of hereditary cancer mutations, as defined by evidence-based guidelines from organizations like the National Comprehensive Cancer Network. The bill also mandates coverage for risk-reducing surgeries (like mastectomies or oophorectomies) when medically appropriate, and increases the frequency of recommended cancer screenings (such as mammograms, colonoscopies, and breast MRI) to at least annually for those with confirmed hereditary cancer gene mutations. These changes apply to Medicare beneficiaries with specific hereditary cancer risk factors, effective upon the bill's enactment.

Maddy summaryThis bill requires Medicare and Medicaid to cover prescription digital therapeutics - software-based treatments for medical conditions like diabetes or mental health disorders - starting January 1, 2024. It mandates Medicare to establish payment rates for manufacturers within one year and create specific billing codes within two years, with temporary codes used until permanent codes are set. Manufacturers must report annual data on pricing, usage, and discounts to Medicare, facing penalties of up to $10,000 per day for incomplete or false reports. The bill directly affects Medicare/Medicaid beneficiaries, digital therapeutic companies, and the healthcare billing system by integrating these treatments into federal coverage.

Maddy summaryThis bill makes permanent Medicare coverage for cardiac and pulmonary rehabilitation services delivered via telehealth in patients' homes, which were temporarily allowed during the pandemic. It removes geographic restrictions that previously required in-person visits or limited services to specific locations like clinics. The change directly affects Medicare beneficiaries needing heart or lung rehabilitation and healthcare providers offering these programs. It ensures home-based telehealth visits for cardiac, intensive cardiac, and pulmonary rehabilitation receive the same coverage as in-clinic services under Medicare.

Maddy summaryThe Stop the Wait Act of 2023 eliminates the current 5-month waiting period for Social Security Disability Insurance (SSDI) benefits by phasing it out: applications filed in 2023-2025 would face a 3-month wait, 2026 a 2-month wait, and 2027 a 1-month wait, with full elimination by January 2028. It also changes Medicare rules to allow individuals without minimum essential health coverage to receive Medicare benefits retroactively from the first month of SSDI eligibility, rather than waiting 24 months. This directly affects people under 65 applying for SSDI who lack other health insurance, ensuring they have coverage during the waiting period. The bill amends the Social Security Act to implement these changes, effective January 1, 2028.

Maddy summaryThis bill changes how Medicare pays for certain outpatient services provided by off-campus hospital departments. It allows these services to be paid under the hospital outpatient payment system (instead of physician fees) if the previous year's total Medicare payments for that physician specialty were under $2 million. It directly affects hospitals with off-campus outpatient departments offering services in specialties with low physician payment volumes. The change applies to services furnished starting in 2024, aiming to stabilize payments for these specific outpatient services.