Rep. Diana Harshbarger

Maddy summaryThis bill creates a Medicare demonstration program to align coverage standards with private insurance. It would deem certain medical services "reasonable and necessary" for Medicare coverage if they are routinely covered by a majority of private health plans in the same state or Medicare contractor area, are safe/effective, and aren't experimental (unless in a qualifying clinical trial). The program would operate for at least 4 years in 5+ states or jurisdictions, with the Secretary establishing rules for what constitutes "significant coverage" through rulemaking. It directly affects Medicare beneficiaries in participating areas and healthcare providers billing Medicare for covered services meeting these criteria. The bill does not change current Medicare coverage rules but tests a new alignment mechanism.

Maddy summaryHR 5385, the Medicare PBM Accountability Act, requires pharmacy benefit managers (PBMs) working with Medicare Part D prescription drug plans to provide detailed transparency reports about drug pricing, rebates, and costs to the plans and the government. The reports must include specific information on each drug covered, such as pricing benchmarks, rebates, cost-sharing for beneficiaries, and how the plan treats generic drugs versus brand-name drugs and biosimilars versus reference products. PBMs must also allow annual audits by the plans to verify the accuracy of their reports and disclose information about their relationships with affiliated pharmacies. These reporting requirements will apply to plan years beginning on or after January 1, 2026. The bill also directs the Government Accountability Office to study existing reporting requirements for transparency in prescription drug costs.

Maddy summaryHR 5400, the NO PBMs Act, requires Medicare Part D prescription drug plans (PDP sponsors) and pharmacy benefit managers (PBMs) to allow any pharmacy meeting basic contract terms to join their networks. This directly affects Medicare beneficiaries by expanding their choice of pharmacies, as current networks often restrict access to specific locations. Key provisions mandate that PDP sponsors and PBMs must accept all eligible pharmacies and establish standardized "reasonable and relevant" contract terms by January 1, 2026. The bill aims to increase pharmacy access without altering drug pricing or plan benefits.

Maddy summaryHR 5193, the Senior Citizens’ Freedom to Work Act of 2023, repeals the Social Security Retirement Earnings Test. This means seniors receiving Social Security benefits who continue working will no longer have their benefits reduced based on their earnings. The bill removes specific provisions in the Social Security Act that previously deducted benefits for individuals under full retirement age who earned above a set limit. The change applies to taxable years ending after December 31, 2023, directly affecting working seniors who previously faced benefit reductions.

Maddy summaryThis bill prevents Medicare from imposing stricter supervision requirements for outpatient physical therapy and occupational therapy than those established by state law, requiring Medicare to follow existing state regulations instead. It takes effect January 1, 2024, directly affecting Medicare-covered therapy services in all states. Additionally, it mandates a Government Accountability Office study by December 2024 to analyze how Medicare’s 15% payment differential for therapy assistants impacts access to care in rural and underserved areas. The study will examine this payment policy across all Medicare Part B settings.

Maddy summaryThis bill amends the Affordable Care Act and Medicaid/CHIP programs to deny health insurance subsidies, coverage, and related benefits to individuals with Deferred Action for Childhood Arrivals (DACA) status. Specifically, it excludes people lawfully present only due to the 2012 DHS memo granting deferred action from eligibility for ACA subsidies, Medicaid, and the State Children's Health Insurance Program (CHIP). The bill requires states to remove DACA recipients from enrollment in health plans and rescind any existing waivers that allowed such coverage. It directly affects approximately 800,000 DACA recipients who currently qualify for ACA subsidies and Medicaid/CHIP under existing rules.

Maddy summaryHR 4712, the Patient Right to Shop Act, prohibits group health plans and health insurance issuers from including contract terms that block third-party tools helping patients compare prescription drug costs. The bill specifically targets contracts with pharmacy benefit managers (PBMs), requiring that plans cannot restrict access to information needed for tools showing all patient costs - like copays, coinsurance, cash prices, or mail-order options. It directly affects patients (who gain clearer cost comparisons), health plans, insurers, and PBMs. The law does not create new tools but ensures existing cost-comparison tools can function by preventing contractual barriers, while clarifying it doesn’t override existing privacy rules like HIPAA.

Maddy summaryThis bill modifies the $800 de minimis exemption for small shipments entering the U.S. duty-free. It excludes goods from nonmarket economy countries and nations on the U.S. trade "priority watchlist" from this exemption. Importers must submit detailed documentation (including origin, value, shipper details, and classification) to U.S. Customs within 180 days of enactment. Providing false information could result in $5,000 civil penalties per violation. The changes apply to shipments entered on or after 180 days after the bill’s enactment.

Maddy summaryThis bill amends Medicare rules to improve access to home infusion therapy, which delivers IV medications at home for conditions like chronic diseases. It adds pharmacy services (including drug preparation and compounding) to covered Medicare benefits and creates a payment rule: if a supplier isn't physically present during therapy, Medicare pays 50% of the full rate instead of denying payment. It also allows nurse practitioners and physician assistants to establish and review home infusion care plans, previously limited to physicians. These changes, effective January 2024, directly affect Medicare beneficiaries requiring home infusion therapy and providers delivering these services.

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.