Maddy summaryThis bill requires Medicare Advantage plans to implement electronic prior authorization systems by 2027 and publish detailed data on their approval and denial rates for medical services by 2026. It directly affects Medicare Advantage plans (private insurers offering Medicare coverage) and their enrollees (seniors 65+), mandating transparency about prior authorization decisions, processing times, and appeal outcomes. Key provisions include requiring plans to report annual statistics on request approvals/denials, average processing times, and use of technology, with this data published publicly by the Centers for Medicare & Medicaid Services. The bill also sets timelines for plan responses to prior authorization requests and mandates reports to Congress on implementation and impacts.
Rep. Seth Moulton
Sponsored bills
Maddy summaryThe MATCH IT Act of 2024 establishes national standards to improve patient matching accuracy in electronic health records. It requires the Secretary to create a uniform definition for measuring patient match rates (accounting for duplicate/overlaid records) and develop a minimum data set to support 99.9% matching accuracy by healthcare systems. The bill mandates incorporating this data set into health IT certification requirements and Medicare interoperability programs within 18-24 months. It also creates a voluntary Medicare bonus for providers meeting 90% patient match rates, with anonymous reporting of accuracy data. This directly affects healthcare providers, health IT vendors, and Medicare participants by requiring standardized matching protocols to reduce medical errors and costs linked to misidentification.
Maddy summaryHR 7142 (Alternatives to PAIN Act) requires Medicare Part D plans to cover non-opioid pain management drugs with no deductible and at the lowest copay level starting in 2025. It defines "qualifying non-opioid drugs" as FDA-approved medications that don’t act on opioid receptors (like certain NSAIDs or nerve pain treatments), excluding opioids and schedule I-III drugs. The bill prohibits Medicare plans from forcing patients to try opioids first (step therapy) or requiring prior approval for these non-opioid options. It directly affects Medicare beneficiaries needing pain management, especially those seeking alternatives to opioids for post-surgical or acute pain. The policy change aims to improve access to non-addictive pain treatments while preserving doctors' authority to prescribe medically appropriate care.
Maddy summaryThe Nutrition CARE Act of 2024 expands Medicare Part B coverage to include medical nutrition therapy services for beneficiaries diagnosed with eating disorders. It directly affects Medicare beneficiaries with eating disorders - particularly an estimated 420,500-560,700 Black, Indigenous, and People of Color seniors - by requiring coverage for 13 hours of initial care (including assessment) and 4 hours annually for ongoing management. The bill amends Medicare law to specify that these services must be provided by registered dietitians or nutrition professionals following referrals from physicians or psychologists. Coverage applies to all eating disorders as defined by the DSM-5, addressing a gap where Medicare previously excluded this critical treatment component. This policy change aims to improve access to evidence-based care for a condition linked to high mortality and significant healthcare costs.
Maddy summaryThe Medical Nutrition Equity Act of 2023 requires Medicare, Medicaid, CHIP, TRICARE, FEHBP, and private health insurance plans to cover medically necessary food for patients with specific digestive and inherited metabolic disorders. The bill defines "medically necessary food" as specialized formulas, vitamins, or amino acids prescribed by a physician for conditions including inherited metabolic disorders, malabsorption syndromes, food allergies, and inflammatory bowel diseases. It mandates coverage for both the food and necessary equipment/supplies to administer it, specifically prohibiting insurers from requiring feeding tubes when oral administration is possible. The bill also establishes that Medicare coverage will be 80% of the cost for these items. This legislation aims to ensure patients with these conditions can access the specialized nutrition therapies they need to prevent serious health complications like malnutrition, hospitalization, or developmental issues.
Maddy summaryHR 6780 establishes a 4-year Medicare demonstration program testing whether hospitals providing medically tailored home-delivered meals to specific patients improves health outcomes and reduces hospital readmissions. The program targets Medicare beneficiaries with diet-sensitive chronic conditions (like diabetes or heart failure) who are at high risk of readmission and meet specific discharge criteria, such as limited daily living activities. Selected hospitals must screen patients, provide at least two tailored meals daily for 12 weeks, and offer medical nutrition therapy, all without patient cost-sharing. The program requires hospitals to submit data for evaluation, with the goal of assessing impacts on hospital admissions, care costs, and patient satisfaction before reporting to Congress in 2027 and 2030.
Maddy summaryThis bill updates the "competitive need limitation" for duty-free imports from beneficiary developing countries under the Trade Act of 1974. It increases the annual cap for eligible imports from $75 million to $600 million and changes how the limit is calculated to count only duty-free entries during a calendar year. The President must restore duty-free treatment for most eligible articles within 120 days of the bill's enactment, with a one-year review period for sensitive products requiring continued withholding. The bill also requires a report to Congress within one year detailing restored and withheld duty-free treatments. This directly affects importers of goods from designated developing countries eligible for trade benefits.
Maddy summaryThe MORE Act (HR 5601) would federally decriminalize cannabis by removing it from the Schedule I list of controlled substances under the Controlled Substances Act. It requires federal courts to expunge non-violent cannabis convictions and associated arrests, with a focus on addressing racial disparities in cannabis enforcement. The bill creates an Opportunity Trust Fund that would allocate 50% of funds to criminal justice programs, 20% to small business assistance for minority cannabis entrepreneurs, and 20% to community reinvestment grants for individuals impacted by the War on Drugs. It also prohibits federal agencies from denying benefits or security clearances based on cannabis use or past cannabis convictions, and establishes a Cannabis Justice Office to administer these programs.
Maddy summaryThe CARE for Moms Act aims to reduce maternal mortality in the United States by improving healthcare access and quality for pregnant and postpartum women, with specific attention to racial disparities. Key provisions include requiring 12-month continuous Medicaid coverage for postpartum individuals (up from 60 days), expanding oral health coverage during pregnancy, and funding State-Based Perinatal Quality Collaboratives through $35 million annual grants. The bill specifically targets the higher maternal mortality rates faced by Black women, who are about 3 times more likely to die from pregnancy-related causes than White women. It also includes provisions for doula services, rural mobile health units, and improved data collection on maternal health outcomes.
Maddy summaryHR 5408, the SSI Savings Penalty Elimination Act, increases the resource limits for Supplemental Security Income (SSI) program eligibility. It raises the individual resource limit from $2,250 to $20,000 (and the couple limit from $1,500 to $10,000) for 2023, with future annual increases tied to inflation using the Consumer Price Index. This change directly affects low-income SSI recipients who currently lose benefits if their savings exceed the current thresholds. The key mechanism is raising these savings limits to reduce the "penalty" for saving modest amounts, while maintaining program integrity through automatic inflation adjustments.