Rep. Ann M. Kuster

Maddy summaryHR 3851, the Access to Breast Cancer Diagnosis Act of 2023, requires most health insurance plans (including group and individual coverage) to cover diagnostic and supplemental breast exams without any out-of-pocket costs like copays or deductibles. This applies to medically necessary exams used to evaluate abnormalities detected during screening (diagnostic) or to screen high-risk individuals without abnormalities (supplemental), following National Comprehensive Cancer Network guidelines. Plans may still require prior authorization for these exams, and state laws providing stronger protections remain in effect. The law takes effect for plan years beginning January 1, 2024.

Maddy summaryThis bill requires Medicare to cover genetic counseling services provided by licensed genetic counselors at 85% of the physician payment rate. It defines "genetic counselor" as a state-licensed professional (or meeting federal criteria in non-licensing states) and mandates a new billing modifier for these services starting January 1, 2024. Medicare beneficiaries seeking genetic counseling would gain expanded access to these services under this coverage. The policy change applies to services furnished on or after the effective date, with implementation via interim rule.

Maddy summaryThe Menstrual Equity For All Act of 2023 requires free menstrual products to be available at no cost in public schools, colleges, correctional facilities, and federal buildings. It makes menstrual products covered by Medicaid, prohibits taxes on these products, and provides funding through social services programs to help low-income individuals access menstrual products. The bill directly affects students (K-12 and college), incarcerated people, homeless individuals, employees (in businesses with 100+ workers), Medicaid beneficiaries, and people receiving Temporary Assistance for Needy Families (TANF). Key provisions include amending school funding to require free products, creating college grant programs for menstrual product distribution, and adding menstrual products to Medicaid coverage and social services programs.

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 summaryThe Bear Protection Act of 2023 (HR 3518) prohibits the interstate and international trade of bear viscera (internal organs like gallbladders) and products containing them, such as traditional medicine ingredients. It directly affects businesses, importers, exporters, and anyone involved in trading these items across state lines or internationally. The bill creates criminal penalties (up to 1 year in prison or $25,000 fines) and civil enforcement through the Department of the Interior, while allowing limited exceptions for wildlife law enforcement and Native American cultural practices. It aims to reduce poaching and habitat loss by cutting demand for bear parts, particularly targeting trade linked to declining bear populations in Asia and the U.S.

Maddy summaryThe FAMILY Act (HR 3481) would establish a national paid family and medical leave insurance program administered by the Social Security Administration. Eligible workers would receive wage replacement benefits (up to 85% of average earnings, with a maximum of $4,000 monthly) for up to 60 caregiving days per 12-month benefit period for qualifying reasons like caring for a sick family member, personal serious health conditions, or responding to domestic violence. The program would be funded through 0.2% payroll taxes from employees and employers (with self-employed individuals paying 0.4%), with benefits coordinated with existing state programs. The law includes protections against employer retaliation for taking leave and requires employers to maintain health coverage during leave periods.

Maddy summaryHR 3417, the FAIR Act, requires hospitals with off-campus outpatient departments (OCODs) to use separate unique health identifiers for those departments by January 1, 2025. It mandates that these departments bill Medicare and other insurers using specific formats (HIPAA X12 837P or CMS 1500) with their unique identifier, rather than billing under individual practitioners. This directly affects hospitals operating OCODs, changing how they submit claims for services provided at those locations. The bill takes effect for claims submitted on or after January 1, 2025, ensuring clearer billing accountability for these departments.

Maddy summaryHR 3355 reauthorizes a federal program providing loan repayment assistance to healthcare professionals working in substance use disorder (SUD) treatment. It makes these repayments tax-free under the Internal Revenue Code and requires detailed annual reporting on applicants, including those denied due to insufficient funding. The program is funded at $75 million annually for fiscal years 2024-2028. This directly supports clinicians in SUD treatment who have student loan debt, helping address workforce shortages in addiction care.

Maddy summaryHR 3207, the Build Housing with Care Act of 2023, creates a $100 million annual grant program to fund the co-location of affordable housing and childcare facilities. It directly affects housing developers, childcare providers, and low-income residents by requiring grantees to partner with qualified childcare centers (serving low-income families or operating in "child care deserts") and avoid evictions during facility development. Key provisions include prioritizing projects in underserved areas, mandating resident engagement, and requiring grantees to use funds for design, construction, or renovation of shared facilities. The program aims to increase childcare access near housing, with annual reports tracking outcomes like new childcare slots and resident usage.

Maddy summary# Summary of Proposed Immigration Legislation This comprehensive immigration bill proposes sweeping reforms across multiple areas of U.S. immigration policy. The key provisions can be categorized as follows: ## Family Immigration Reforms - Expands eligibility for family-based visas - Creates new pathways for family reunification - Reforms the "child out" rule for H-4 visa holders who age out - Establishes new procedures for sponsors of unaccompanied children ## Employment-Based Immigration - Increases diversity visas from 55,000 to 80,000 - Creates new categories for doctoral STEM graduates - Eliminates per-country limits for employment-based visas - Addresses visa backlogs by creating new categories for beneficiaries with priority dates over 10 years old - Increases visa numbers for certain employment-based categories (e.g., 23.55% instead of 28.6% for certain categories) - Creates a Regional Economic Development Immigrant Visa Pilot Program (10,000 visas annually) ## Diversity and Integration Programs - Creates a United States Citizenship and Integration Foundation to promote citizenship preparation - Establishes pilot programs for immigrant integration at state and local levels - Creates English as a Gateway to Integration grant program ($100 million for 2024-2025) - Creates Workforce Development and Shared Prosperity grant program ($100 million for 2024-2025) - Requires in-state tuition rates for refugees, asylees, and certain special immigrants - Waives English requirements for seniors applying for naturalization ## Immigration Court Reforms - Increases immigration judge numbers by 55 annually through 2028 - Creates a right to counsel for vulnerable individuals (children, victims of abuse, etc.) - Establishes an Immigration Counsel Fund with a $25 surcharge on immigration fees - Requires all noncitizens to receive legal orientation programs - Modernizes court technology for improved efficiency - Creates procedures for ensuring court appearance compliance ## Refugee and Asylum Processing - Expands alternatives to detention for family units - Improves processing for asylum seekers - Creates programs to facilitate safe and efficient repatriation - Establishes reintegration support for repatriated individuals ## Naturalization and Citizenship - Creates citizenship pathways for U.S. high school graduates - Waives English requirements for seniors - Creates a National Citizenship Promotion Program - Establishes naturalization ceremonies at historic locations The bill aims to create a more efficient immigration system, address backlogs in immigration courts, promote immigrant integration, create clearer pathways to citizenship, and reform both family-based and employment-based immigration systems. It represents a comprehensive approach to modernizing U.S. immigration policy.