Rep. Ann M. Kuster

Maddy summaryHR 3086, the "Find It Early Act," requires health insurance plans to cover breast cancer screenings with no cost-sharing for certain individuals at higher risk of breast cancer. The bill affects people with increased risk (based on medical criteria or dense breast tissue) or those needing screening due to factors like age, race, ethnicity, or family history. Key provisions mandate coverage for 2D/3D mammograms, ultrasounds, MRI, and other technologies without frequency limits for these groups. This applies to group health plans, Medicare, Medicaid, TRICARE, and VA healthcare systems starting January 1, 2024. The law aims to improve early detection by removing financial barriers to necessary screenings.

Maddy summaryThe PASTEUR Act establishes a new subscription payment model to incentivize development of new antimicrobial drugs for resistant infections. It creates a Committee on Critical Need Antimicrobials and a Subscription Contract Office to manage payments based on specific drug characteristics like treating multi-drug resistant infections, novel mechanisms of action, and oral administration. Under this model, the government would pay drug developers up to $3 billion over 10 years for qualifying drugs, with payments tied to requirements like ensuring drug availability, reporting resistance data, and developing appropriate use plans. The bill aims to address the lack of new antimicrobial drugs by changing the funding model to reward drugs that meet specific clinical and public health needs.

Maddy summaryThe I CAN Act (Improving Care and Access to Nurses Act) expands healthcare access by removing barriers for nurse practitioners, clinical nurse specialists, physician assistants, certified registered nurse anesthetists, and certified nurse-midwives within Medicare and Medicaid programs. Key provisions include allowing these professionals to provide cardiac and pulmonary rehabilitation services, prescribe certain diabetic shoes, and deliver hospice care without unnecessary physician supervision. The bill also clarifies reimbursement for services provided by certified nurse anesthetists and improves access to home health services through certified nurse-midwives. These changes directly affect Medicare and Medicaid beneficiaries by potentially increasing access to care and healthcare providers by expanding their scope of practice. The bill aims to improve healthcare delivery by leveraging the skills of advanced practice nurses across multiple care settings.

Maddy summaryThis bill establishes a new workplace violence prevention standard for healthcare and social service workers. It requires employers in covered facilities - including hospitals, nursing homes, mental health clinics, and social service settings - to develop and implement comprehensive prevention plans with specific requirements. These plans must include risk assessments, hazard prevention measures, employee training on violence prevention, and procedures for reporting and investigating violent incidents. The bill also amends Medicare regulations to require compliance with these standards for hospitals and skilled nursing facilities receiving Medicare funds.

Maddy summaryThe Pharmacy Benefits Manager Accountability Act requires pharmacy benefits managers (PBMs) and health insurance issuers to provide detailed annual reports to plan sponsors (like employers) about drug spending, rebates, and formulary decisions. These reports must include specific data on drugs dispensed, costs, patient out-of-pocket spending, rebates received from manufacturers, and net spending after rebates, all in machine-readable format. The bill establishes penalties of up to $10,000 per day for failure to provide required information and $100,000 per item for false information. It also directs a GAO study on pharmacy networks and common ownership structures to assess potential anti-competitive practices.

Maddy summaryHR 2474, the "Strengthening Medicare for Patients and Providers Act," changes how Medicare pays physicians for services. It replaces the previous two-part payment system (used through 2025) with a single annual payment rate update starting in 2024. This update will be based on the Medicare Economic Index (MEI), which tracks costs for medical providers. The change directly affects Medicare-certified doctors and clinics who receive payments under the physician fee schedule.

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 modifies Medicare's rules for clinical laboratory testing to reduce administrative burdens. It requires the use of statistically valid sampling (instead of full reporting) for "widely available" tests - defined as tests costing under $1,000 per test with over 100 labs performing them - to determine payment rates starting in 2026. The bill also delays reporting deadlines until 2027, updates how labs are defined for payment purposes, and adds annual payment increase caps (2.5% for common tests in 2024-2025, rising to 5% by 2028). These changes directly affect Medicare-participating labs, particularly independent and hospital-based labs conducting common tests.

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 summaryHR 1692, the Health Care Affordability Act of 2023, adjusts how health insurance subsidies are calculated for people buying coverage through the marketplace. It replaces the previous subsidy formula with a sliding scale based on income, where households earning up to 150% of the poverty line pay 0% of premiums, and those at 400% or more pay 8.5%. The change applies to all income tiers between these points, with percentages increasing incrementally (e.g., 2% for 150-200% income). This directly affects individuals purchasing health insurance through the marketplace who qualify for subsidies under the Affordable Care Act. The bill amends Section 36B of the Internal Revenue Code and takes effect for tax years beginning after December 31, 2022.