Rep. Michael C. Burgess

Maddy summaryHR 7142 (Alternatives to PAIN Act) requires Medicare Part D plans to cover non-opioid pain management drugs with no deductible and at the lowest copay level starting in 2025. It defines "qualifying non-opioid drugs" as FDA-approved medications that don’t act on opioid receptors (like certain NSAIDs or nerve pain treatments), excluding opioids and schedule I-III drugs. The bill prohibits Medicare plans from forcing patients to try opioids first (step therapy) or requiring prior approval for these non-opioid options. It directly affects Medicare beneficiaries needing pain management, especially those seeking alternatives to opioids for post-surgical or acute pain. The policy change aims to improve access to non-addictive pain treatments while preserving doctors' authority to prescribe medically appropriate care.

Maddy summaryHR 6794 extends the Medicare Independence at Home Medical Practice Demonstration Program from a 10-year to a 12-year duration. The program provides home-based medical care for Medicare beneficiaries, primarily elderly or disabled patients who prefer receiving care at home rather than in facilities. The bill requires the Secretary of Health and Human Services to submit a report to Congress within one year of enactment, evaluating the program's effectiveness in improving health outcomes and identifying barriers to participation. This change directly affects Medicare beneficiaries eligible for home-based care and the healthcare providers participating in the demonstration program.

Maddy summaryHR 6790 establishes National Institutes of Health centers to advance research, early detection, and public awareness of rare kidney diseases, with a focus on rural and underserved communities. It mandates a federal study on genetic testing barriers, treatment patterns, and public awareness for rare kidney diseases affecting disproportionately impacted populations, including barriers to insurance coverage and access to specialists. The bill also funds nephrology training programs to increase specialists serving these communities and requires experiments to delay or prevent the need for dialysis and transplants. Total funding of $7 million is authorized for fiscal years 2024-2028 to support these research, education, and early intervention efforts.

Maddy summaryThe Preserving Seniors’ Access to Physicians Act of 2023 increases the Medicare payment adjustment rate for physicians from 1.25% to 4.62%, directly affecting doctors who treat Medicare patients (primarily seniors). It also reduces the funding for the Medicaid improvement fund from $5,796,117,810 to $3,973,117,810. These changes impact Medicare providers and Medicaid programs, with the Medicare adjustment aimed at supporting physicians adjusting to payment changes. The bill does not specify how the Medicaid funding reduction relates to its stated goal of preserving seniors' access to physicians.

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.

Maddy summaryThis bill updates Medicare physician payment rules to improve stability and accuracy. It raises the budget neutrality threshold from $20 million (pre-2025) to $53 million in 2025, with annual indexing after 2026, to prevent excessive payment adjustments. The bill requires the Medicare program to correct budget neutrality payments based on actual service utilization data (not estimates) starting in 2025, and mandates updating direct cost inputs (like staff wages and equipment prices) every 5 years. It also caps annual changes to the physician payment conversion factor at 2.5% to limit sudden payment shifts, directly affecting Medicare physicians and healthcare providers receiving these payments.

Maddy summaryThis bill extends the Small Practice, Underserved, and Rural Support (SURS) program under Medicare's Quality Payment Program through fiscal year 2029. It directly affects small, rural, and underserved healthcare practices by maintaining their eligibility for enhanced payment adjustments. The key mechanism inserts a six-year funding extension (2024-2029) into existing Medicare law, ensuring continued financial support for these practices. The change provides stability to the program without altering its core structure or eligibility rules.

Maddy summaryThe Maintaining Investments in New Innovation Act (HR 5547) extends the exclusivity period for certain advanced drugs from 7 to 11 years. It defines an "advanced drug product" as a drug using genetically targeted technology to change how genes work, such as drugs that suppress or activate gene function. The bill amends the Social Security Act to update the definition of "qualifying single source drug" to include these advanced therapies with the longer exclusivity period. This change directly affects drug manufacturers developing such advanced therapies and influences Medicare's drug coverage rules by delaying generic competition for these specific treatments.

Maddy summaryHR 5391 requires drug manufacturers to pay rebates to Medicare when the price of certain high-cost cancer drugs (called "selected drugs") exceeds a negotiated "maximum fair price" (MFP). This applies to Medicare Part B beneficiaries using these specific drugs, lowering their out-of-pocket costs. The bill mandates manufacturers to calculate rebates based on the difference between current Medicare payment rates (ASP+6) and the new MFP-based rates, reducing beneficiary coinsurance from ASP+6 to MFP+6. The rebates are deposited into Medicare's trust fund and apply to drugs already subject to MFP negotiations under existing law.

Maddy summaryThe Preserving Access to Home Health Act of 2023 repeals a 2018 payment adjustment for Medicare home health agencies, restoring prior payment rates for 2024 and subsequent years. It requires the Medicare Payment Advisory Commission (MedPAC) to analyze how home health agencies' financial performance affects access to care, including reviewing spending and utilization data across Medicare, Medicaid, and other payers. Starting in 2025, the bill mandates home health agencies to report detailed data on visit volumes and payments by payer source (Medicare, Medicaid, private insurers) through updated cost reports. This data will help MedPAC assess payment policy impacts on access to home health services for Medicare beneficiaries.