Rep. Michael C. Burgess

Maddy summaryThis bill creates an exemption for Medicare Advantage plan physicians who had at least 90% of their prior authorization requests approved for specific services in the previous year. These doctors would be exempt from needing pre-approval for those same services in subsequent plan years, reducing administrative delays for patients. The exemption continues until revoked (based on updated approval rates) or the physician opts out. It also requires plans to allow providers to discuss treatment plans with a qualifying physician during the authorization process.

Maddy summaryHR 4473, the Medicare Patient Access to Cancer Treatment Act, requires Medicare to pay the same rate for cancer care services whether provided in a hospital outpatient department or a physician’s office. It directly affects Medicare beneficiaries receiving cancer treatment and healthcare providers (hospitals and physician offices) who deliver cancer care services. The bill mandates equal reimbursement for defined cancer care services - such as chemotherapy administration and cancer diagnosis/treatment - starting in 2025, eliminating current higher payments for hospital settings. This change aims to reduce unnecessary cost increases for Medicare (estimated $615 million added between 2015-2019 due to current payment disparities) without altering care quality.

Maddy summaryHR 4402 clarifies transparency reporting requirements for pharmaceutical manufacturers. It adds specific educational materials - like peer-reviewed journals, journal reprints, medical conference reports, and textbooks - to the list of items manufacturers must report when transferring value to healthcare providers. This change directly affects drug manufacturers who provide these educational resources to doctors or institutions. The bill expands existing reporting rules under the Social Security Act to ensure greater transparency about such transfers. The amendment applies to transfers made on or after the law's enactment date.

Maddy summaryThis bill requires Medicare to cover genetic counseling services provided by licensed genetic counselors at 85% of the physician payment rate. It defines "genetic counselor" as a state-licensed professional (or meeting federal criteria in non-licensing states) and mandates a new billing modifier for these services starting January 1, 2024. Medicare beneficiaries seeking genetic counseling would gain expanded access to these services under this coverage. The policy change applies to services furnished on or after the effective date, with implementation via interim rule.

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 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 summaryThe Emergency Care Improvement Act would permanently allow freestanding emergency centers (FECs) to receive Medicare and Medicaid reimbursement for emergency services. FECs are independently licensed facilities operating 24/7 with on-site physicians, providing emergency care equivalent to hospital-based emergency rooms. The bill sets payment rates for FECs equal to hospital outpatient department rates for higher-level emergency services, based on existing Medicare payment structures. This change would apply to over 110 FECs, mostly in Texas, which previously operated under a temporary pandemic waiver and demonstrated 21.8% cost savings to Medicare for similar care.

Maddy summaryHR 1666 extends deadlines for ambulance service reimbursement rules under Medicare. It amends Section 1834(l) of the Social Security Act by changing dates from 2025 to 2028 in two specific provisions: paragraph (12)(A) and paragraph (13)(A). This delay gives ambulance providers additional time to adjust to existing Medicare payment rules. The bill directly affects Medicare-certified ambulance services and the patients relying on ground ambulance care covered by Medicare.

Maddy summaryThis bill repeals specific provisions from the Affordable Care Act and its 2010 amendment that restricted certain physician referrals to hospitals under Medicare. It directly affects hospitals and physicians who previously faced limitations on referring Medicare patients to facilities they owned or had financial ties with. The key mechanism restores the original rules that allowed such referrals without the prior restrictions, effectively undoing the 2010 changes. This is a procedural change to existing law, not a new policy.