Rep. A. Drew Ferguson IV

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 would require Medicare to cover FDA-approved blood tests that screen for multiple cancers simultaneously (like breast, lung, or colorectal cancer) for beneficiaries. It directly affects Medicare recipients aged 65+ who could access these new screenings once per year, without prior authorization. The key provision adds "multi-cancer early detection screening tests" to Medicare's covered services under Part B, defining them as blood tests analyzing cell-free DNA, while maintaining existing coverage for standard screenings like mammograms. The bill does not change current coverage for individual cancer screenings but ensures Medicare keeps pace with new medical technology.

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 Emergency Care Improvement Act would permanently allow freestanding emergency centers (FECs) to receive Medicare and Medicaid reimbursement for emergency services. FECs are independently licensed facilities operating 24/7 with on-site physicians, providing emergency care equivalent to hospital-based emergency rooms. The bill sets payment rates for FECs equal to hospital outpatient department rates for higher-level emergency services, based on existing Medicare payment structures. This change would apply to over 110 FECs, mostly in Texas, which previously operated under a temporary pandemic waiver and demonstrated 21.8% cost savings to Medicare for similar care.

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 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 summaryThe Secure the Border Act of 2023 is a comprehensive immigration bill that focuses on strengthening border security, reforming asylum processes, and updating employment verification systems. The bill requires the immediate resumption of border wall construction, mandates specific staffing levels for Border Patrol agents, and establishes new technology investment plans for Customs and Border Protection. It also introduces stricter asylum eligibility rules, expands penalties for visa overstays, and creates a new employment eligibility verification system that requires employers to check worker authorization status. Additionally, the bill includes provisions for family detention standards, child repatriation policies, and increased funding for border security operations while prohibiting certain types of funding for organizations that facilitate illegal immigration.

Maddy summaryHR 497, the Freedom for Health Care Workers Act, eliminates a federal requirement for healthcare workers in Medicare and Medicaid programs to be vaccinated against COVID-19. The bill directly affects healthcare providers who treat patients under these federally funded programs by preventing the enforcement of the November 2021 HHS rule mandating staff vaccinations. Its key provision prohibits the Department of Health and Human Services from implementing, enforcing, or creating a similar rule regarding vaccination for these workers. This bill changes the policy by removing a specific vaccine mandate for providers in Medicare and Medicaid programs.