Rep. Rick W. Allen

Maddy summaryThis bill establishes a minimum payment floor for Medicare reimbursements to rural hospitals not located in frontier states. It sets a 0.85 minimum for the area wage index used in hospital inpatient payments (starting October 2023) and a similar floor for outpatient department payments (starting January 2024). This prevents Medicare payments from dropping below 85% of the standard wage index for eligible rural hospitals. The bill includes budget neutrality requirements to ensure overall Medicare payments don't increase, while exempting hospitals already receiving payments above the floor.

Maddy summaryHR 3561, the PATIENT Act of 2023, requires hospitals, health insurance plans, and pharmacy benefit managers to publicly disclose detailed pricing information for healthcare services and drugs. Hospitals must publish standard charges for 300+ shoppable services, including gross charges, payer-specific negotiated rates, and discounted cash prices, with updates required annually. Health plans must provide real-time information on in-network rates, cost sharing, deductibles, and prior authorization requirements for covered services. The bill establishes enforcement mechanisms, including civil monetary penalties for non-compliance, with fines ranging from $300 per day for small hospitals to $5 million for large hospitals that fail to comply with the transparency requirements.

Maddy summaryHR 3285, the Fairness for Patient Medications Act, requires health insurance plans and pharmacy benefit managers to limit patient cost-sharing for "highly rebated drugs" (drugs where manufacturers rebate over 50% of annual spending). Starting January 2025, plans must cap out-of-pocket costs per 30-day supply at 1/12 of the drug’s net price (after rebates), calculated annually. The bill also prohibits hidden discounts from drug manufacturers when plans add previously excluded drugs to coverage, requiring price reductions to be visible at checkout or limited to flat service fees. This directly affects health insurance plans, insurers, and pharmacy benefit managers managing prescription drug coverage.

Maddy summaryThis bill prohibits federal funding for gender transition procedures - including hormone therapy, puberty blockers, and surgeries like genital reassignment - across all federal programs and health plans. It exempts procedures for medical conditions (such as disorders of sex development) and treatment of complications arising from such procedures. The bill also blocks Affordable Care Act premium tax credits and cost-sharing reductions for health plans covering these services, though individuals may purchase separate non-federal-funded coverage. State and private insurers can still offer such coverage using their own funds, but federal subsidies cannot be applied to it.

Maddy summaryThis bill regulates pharmacy benefit managers (PBMs) working with Medicare Part D prescription drug plans. It prohibits PBMs from earning income based on drug prices or rebates (requiring flat fees instead), mandates equal reimbursement for all network pharmacies, and requires PBMs to report how much of drug rebates they pass through to Medicare plans. The law also mandates annual compliance certifications and requires the government to publish aggregated transparency data (without revealing specific plan details) starting in 2024. These changes directly affect Medicare Part D plans and the seniors who rely on them for prescription drug coverage.

Maddy summaryThis bill expands Medicare Part B coverage to include specific pharmacist services, directly affecting Medicare beneficiaries and pharmacists who provide these services. It adds new coverage for pharmacist evaluations and treatments related to certain illnesses (like COVID-19, flu, or strep throat) and public health emergencies, requiring payment at 80% of the lesser of actual charge or 85% of physician payment rates (100% during emergencies). The bill also prohibits balance billing for these services, ensuring beneficiaries pay only the standard Medicare copayment. These changes aim to improve access to pharmacist care during health crises while aligning payment with existing physician service frameworks.

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 summaryThis bill repeals specific provisions from the Affordable Care Act and its 2010 amendment that restricted certain physician referrals to hospitals under Medicare. It directly affects hospitals and physicians who previously faced limitations on referring Medicare patients to facilities they owned or had financial ties with. The key mechanism restores the original rules that allowed such referrals without the prior restrictions, effectively undoing the 2010 changes. This is a procedural change to existing law, not a new policy.

Maddy summaryThis bill would require employer-sponsored health plans and group health insurance to treat telehealth services as "excepted benefits," meaning they would no longer need to comply with certain federal rules that apply to most health coverage (like pre-authorization requirements). It directly affects employers offering group health plans and insurers providing group coverage, making telehealth services subject to fewer regulatory standards. The key change is adding "Benefits for telehealth services" to the list of exceptions under the Public Health Service Act, ERISA, and tax code. This would take effect for plan years beginning after the bill's enactment.

Maddy summaryThis bill targets specific Mexican cartels (Sinaloa, Jalisco New Generation, Beltran-Levya, Gulf, Los Zetas, Tijuana, and La Familia Michoacana/Knights Templar) by increasing penalties for related crimes, prohibiting cartel members from using U.S. financial institutions, and creating a CARTEL Fund to distribute seized assets (75% to Homeland Security, 25% to Justice Department). It establishes new immigration barriers for cartel members and their family members, and imposes penalties on U.S. citizens who facilitate cartel activities. The bill also authorizes sanctions against foreign governments and individuals that support these cartels, including blocking transactions and denying visas. This legislation would directly affect cartel members, their associates, U.S. citizens facilitating cartel activities, and foreign entities supporting these organizations.