Rep. Susie Lee

Maddy summaryThe Essential Caregivers Act of 2024 requires nursing homes and similar facilities to allow residents to designate essential caregivers who provide emotional support or assistance with daily activities. During emergencies when regular visitation is restricted, facilities must permit at least one essential caregiver access to residents daily and cannot deny access without following specific procedures. Facilities may deny access for a maximum of 7 days during emergencies (or 14 days with state approval), and must provide a written explanation and appeal process if access is denied. The bill establishes a 48-hour appeal process for residents and caregivers to challenge denials, with facilities required to prove violations during appeals. This law applies to Medicare skilled nursing facilities, Medicaid nursing facilities, intermediate care facilities, and certain inpatient rehabilitation facilities.

Maddy summaryHR 8227 removes Medicare's requirement for an initial in-person visit before covering mental health services delivered via telehealth. It directly affects Medicare beneficiaries seeking mental health care, allowing them to receive these services remotely without first needing an in-person appointment. The bill amends Medicare rules to eliminate geographic restrictions for telehealth mental health visits, effective July 1, 2019, or after the end of the public health emergency period. This change applies to services provided through rural health clinics and federally qualified health centers as well, streamlining access to mental health care via technology.

Maddy summaryThe EASE Act of 2024 requires the Centers for Medicare & Medicaid Services (CMS) to test a new model improving access to specialty health care for Medicare and Medicaid beneficiaries in rural or underserved areas. It mandates CMS to partner with selected provider networks - comprising at least 50 community health clinics, nonprofits with proven community health work, and commitment to research - to deliver specialty care via telehealth and remote technology, coordinated with patients’ primary care providers. This model directly affects Medicare Part A/B beneficiaries and Medicaid enrollees living in designated underserved regions. The bill establishes specific criteria for network selection and defines "eligible individuals" based on coverage type and geographic location.

Maddy summaryThis bill, the EMPSA Act (Eliminating the Marriage Penalty in SSI Act), changes Social Security Income (SSI) rules for married adults with intellectual or developmental disabilities. It directly affects married individuals aged 18+ who have these disabilities and meet income and resource limits. The key change removes the "marriage penalty" by ensuring their spouse’s income and resources no longer count against their SSI eligibility or benefit amount, allowing them to receive the full individual benefit rate. This update modifies specific sections of the Social Security Act to eliminate the previous disadvantage faced by married couples under these disability conditions.

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 summaryHR 5819, the COMPLETE Care Act, incentivizes Medicare primary care providers to integrate behavioral health services by increasing payments for specific services (like mental health and substance use disorder support) during 2025-2027. Providers using designated HCPCS codes for integrated care would receive 125-175% of standard payment rates, with the percentage declining annually. The bill also requires these providers to report on integration quality measures and mandates technical assistance for practices adopting integrated models, funded through new appropriations for 2024-2027. It directly affects Medicare-participating primary care practices serving beneficiaries needing mental health or substance use services.

Maddy summaryHR 5663, the ALS Better Care Act, creates a new Medicare payment system to improve reimbursement for specialized care services provided to ALS patients. It establishes a $800 per visit payment rate starting in 2025 for qualified ALS care facilities, with annual increases based on market basket adjustments. The bill requires the Comptroller General to report on appropriate payment amounts and ensures this new payment is in addition to, not replacing, existing Medicare payments for ALS-related services. This aims to reduce wait times, support facilities in rural areas through telehealth access, and address funding challenges for ALS clinical trials.

Maddy summaryThe Health Insurance Price Transparency Act of 2023 requires most group health plans and health insurance issuers to provide clear, upfront pricing information to consumers. It mandates that plans make cost-sharing details (like deductibles and copayments) available to individuals through user-friendly online tools that provide real-time responses. The bill also requires plans to publicly post detailed rate and payment information, including in-network rates, maximum allowed amounts, and payment details for drugs and services, in machine-readable formats that can be easily compared. These requirements apply to most group health plans (excluding grandfathered plans) and take effect for plan years beginning two years after the law's enactment.

Maddy summaryThe PrEP Access and Coverage Act of 2023 requires private health insurance plans, Medicare, Medicaid, and other public health programs to cover pre-exposure prophylaxis (PrEP) for HIV prevention without cost-sharing, including the medication, related lab tests, and follow-up care. The bill also prohibits life, disability, and long-term care insurance companies from denying coverage or charging higher premiums to people taking PrEP. It establishes public education campaigns to increase awareness of PrEP and PEP (post-exposure prophylaxis) and creates funding for state and community programs to expand access to HIV prevention services, particularly for populations disproportionately affected by HIV including Black, Hispanic/Latinx, and transgender individuals. The legislation specifically addresses current disparities in PrEP access, as data shows only 11% of Black/African American and 21% of Hispanic/Latinx individuals eligible for PrEP received prescriptions in 2022 compared to 82% of White individuals. Coverage requirements for most plans will take effect on January 1, 2025.

Maddy summaryHR 3875, the Expanded Telehealth Access Act, expands Medicare coverage for telehealth services by adding new healthcare professionals to the list of providers eligible for payment. It specifically includes licensed audiologists, occupational therapists (and their assistants under supervision), physical therapists (and their assistants under supervision), and speech-language pathologists. The bill ensures these providers are paid the same rate for telehealth services as they would be for in-person care under Medicare. This change directly affects Medicare beneficiaries seeking remote therapy services and the new provider types who can now offer these services via telehealth.