Maddy summaryThis bill updates Medicare's physician fee schedule to better align with current healthcare costs and support providers. It extends a key deadline for geographic payment adjustments from 2024 to 2025, increases the rate for payment adjustments from 1.25% to 3%, and extends incentive payments for doctors in alternative payment models (APMs) through 2026. For 2026, it imposes payment reductions (34% for 4-6 years in APMs, 67% for 7+ years) but allows exceptions if providers increased their financial risk compared to 2025. The bill also raises Medicare's budget neutrality threshold to $53 million in 2025 and requires regular updates to cost data (like staff wages and equipment prices) every five years. These changes directly affect Medicare-participating physicians, especially those in APMs, by altering payment calculations and incentives.
Rep. Nick LaLota
Sponsored bills
Maddy summaryThis bill prevents Medicare from publicly disclosing a physician's or practitioner's home address if they provide telehealth services from home and the address is required for enrollment or billing. It directly affects doctors and healthcare providers who choose to deliver telehealth services from their residences. The key provision amends Medicare rules to ensure that even when an address is needed for administrative purposes, the home location remains private and cannot be shared publicly. This is a specific privacy safeguard, not a broad policy change to telehealth services.
Maddy summaryThe Maximum Pressure Act (HR 6114) is a legislative proposal that would maintain and expand U.S. sanctions against Iran. The bill would codify existing sanctions, require Iran to meet 12 specific conditions before sanctions could be lifted (including ending support for terrorism, releasing hostages, and ending nuclear enrichment), and expand sanctions on Iran's Revolutionary Guard Corps and missile programs. It also establishes new reporting requirements for the U.S. government to monitor Iran's activities and the impact of sanctions. The legislation would require congressional review before any sanctions could be lifted or modified, preventing the executive branch from unilaterally easing restrictions.
Maddy summaryThis bill expands Medicare coverage to include home infusion treatment for people with Alpha-1 Antitrypsin Deficiency Disorder, a genetic condition causing lung and liver damage. It specifically covers "augmentation therapy" (a standard treatment using Alpha-1 Proteinase Inhibitor) when administered in a patient's home by qualified providers. Medicare will pay 80% of the cost for intravenous kits and up to 2 hours of nursing care during these home infusions, starting January 1, 2025. The change directly affects Medicare beneficiaries with this condition who require home-based treatment and their qualified home infusion providers.
Maddy summaryThis bill prohibits Medicare from paying for certain custom-fitted or custom-fabricated orthotic and prosthetic devices delivered via "drop shipment" (direct shipping without in-person training from a qualified provider). It directly affects Medicare beneficiaries who need these devices, ensuring they receive necessary in-person fitting and training. The bill also expands which healthcare professionals (including physical therapists, occupational therapists, orthotists, and prosthetists) can prescribe these devices and updates definitions to clarify terms like "orthoses" and "prostheses." Final regulations implementing these changes must be issued within one year of the bill's enactment.
Maddy summaryThe CONNECT for Health Act of 2023 aims to expand access to telehealth services under Medicare by removing barriers that previously limited who could provide these services and where they could be delivered. The bill eliminates geographic restrictions on telehealth coverage, allows telehealth services to be provided from the patient's home and other clinically appropriate locations, and expands the types of healthcare providers who can offer telehealth services. It also improves the process for adding new telehealth services to Medicare coverage and includes provisions to ensure quality measurement includes telehealth services. This legislation directly affects Medicare beneficiaries seeking remote care and healthcare providers delivering telehealth services, with key provisions taking effect between 2024 and 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.
Maddy summaryHR 3842, the Expanding Access to Diabetes Self-Management Training Act of 2023, would improve Medicare coverage for diabetes self-management training (DSMT) services for beneficiaries with diabetes. The bill expands provider eligibility to include nonphysician practitioners (like nurse practitioners), increases available training hours (initial 10 hours plus up to 2 hours annually), and requires 100% Medicare coverage with no out-of-pocket costs for beneficiaries. It also mandates a new demonstration project starting in 2025 to test virtual DSMT services, evaluating impacts on health outcomes (like A1c levels), hospitalizations, and program costs. This legislation directly affects Medicare beneficiaries with diabetes and healthcare providers offering DSMT services.
Maddy summaryHR 3033, the Solidify Iran Sanctions Act of 2023, repeals the expiration date (sunset) from the 1996 Iran Sanctions Act. This permanently maintains existing U.S. sanctions targeting Iran's weapons programs, ballistic missile development, and support for terrorism. The bill directly affects Iran's government and entities involved in these activities by ensuring sanctions remain in effect without needing periodic renewal. It does not impose new sanctions but preserves current policy by removing the automatic expiration provision.
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.