Rep. Kim Schrier

Maddy summaryThis bill requires health insurance plans to cover three primary care visits and three behavioral health visits per year with no patient cost-sharing (like copays or deductibles). It applies to employer-sponsored health plans and individual insurance policies under ERISA, the Public Health Service Act, and tax code provisions. Plans must treat these visits equally to other covered care, with no stricter limits or lower reimbursement rates. The requirement takes effect two years after the bill's enactment.

Maddy summaryThe Patient Debt Relief Act requires Medicare-participating hospitals to establish clear financial assistance policies by January 2026, including publicly available eligibility criteria and 30-day pre-payment screening for charity care. It prohibits hospitals from placing home liens, garnishing wages, or selling debt to collectors without offering income-based repayment plans (capping payments at 4% of gross monthly income) and eliminates interest for patients earning under 250% of the poverty line. Hospitals failing to comply face civil penalties up to $1 million per violation. The bill also creates a $100 million grant program to fund nonprofits that discharge medical debt for individuals meeting income thresholds (5% of income or under 400% of poverty line), with quarterly reporting requirements. These provisions apply directly to hospitals and low-income patients with medical debt.

Maddy summaryThis bill requires Medicare Advantage plans to implement electronic prior authorization systems by 2027 and publish detailed data on their approval and denial rates for medical services by 2026. It directly affects Medicare Advantage plans (private insurers offering Medicare coverage) and their enrollees (seniors 65+), mandating transparency about prior authorization decisions, processing times, and appeal outcomes. Key provisions include requiring plans to report annual statistics on request approvals/denials, average processing times, and use of technology, with this data published publicly by the Centers for Medicare & Medicaid Services. The bill also sets timelines for plan responses to prior authorization requests and mandates reports to Congress on implementation and impacts.

Maddy summaryThis bill establishes Medicare coverage for diabetes prevention program services to help prevent type 2 diabetes in at-risk beneficiaries. It defines these services as structured behavioral health sessions following a CDC-approved curriculum, available to Medicare beneficiaries who haven't been diagnosed with diabetes (other than gestational diabetes) and meet specific medical criteria. The bill creates a new payment structure for diabetes prevention program suppliers, requiring them to be recognized by the CDC and meet administrative requirements for tracking participant data and maintaining program standards. It also sets a transition deadline of January 1, 2025, for ending the previous Medicare Diabetes Prevention Program Expanded Model and requires a report on the program's impact by 2028.

Maddy summaryThe State Public Option Act creates a new Medicaid buy-in program allowing individuals without other health insurance to purchase coverage starting January 1, 2025. This program limits premiums to 8.5% of household income and requires states to cover comprehensive sexual and reproductive health services, including abortion, beginning in 2025. The bill also establishes how Affordable Care Act premium tax credits apply to this coverage and includes provisions for quality measures and payment rates for primary care services under Medicaid.

Maddy summaryThe Medical Nutrition Equity Act of 2023 requires Medicare, Medicaid, CHIP, TRICARE, FEHBP, and private health insurance plans to cover medically necessary food for patients with specific digestive and inherited metabolic disorders. The bill defines "medically necessary food" as specialized formulas, vitamins, or amino acids prescribed by a physician for conditions including inherited metabolic disorders, malabsorption syndromes, food allergies, and inflammatory bowel diseases. It mandates coverage for both the food and necessary equipment/supplies to administer it, specifically prohibiting insurers from requiring feeding tubes when oral administration is possible. The bill also establishes that Medicare coverage will be 80% of the cost for these items. This legislation aims to ensure patients with these conditions can access the specialized nutrition therapies they need to prevent serious health complications like malnutrition, hospitalization, or developmental issues.

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 prohibits health insurance plans from charging healthcare providers fees for electronic payments (EFTs) and payment advice transactions. It directly affects doctors, hospitals, and clinics that receive electronic payments from health plans by banning any charges, including withholdings, for these transactions. The law, effective January 1, 2024, amends the Social Security Act to require health plans to cover these costs themselves, eliminating fees for providers.

Maddy summaryHR 6369 extends Medicare incentive payments for healthcare providers participating in "eligible alternative payment models" (APMs), which are alternative Medicare payment structures for doctors and clinics. The bill updates payment rules to cover 2026 instead of 2025, adding a new rule that reduces 2026 payments by 34% for providers in their 4th-6th year of APM participation and by 67% for those in their 7th year or longer. These changes directly affect Medicare-certified healthcare professionals and organizations enrolled in APMs, altering their payment incentives based on years of participation. The bill amends Section 1833(z) of the Social Security Act to adjust payment timelines and reduction percentages, with related updates to other Medicare payment provisions.

Maddy summaryHR 5840, the Transportation Security Screening Modernization Act of 2024, simplifies the process for transportation workers to obtain multiple TSA security credentials. It requires the TSA to allow individuals to apply for and renew programs like the TWIC (Transportation Worker Identification Credential) and HAZMAT Endorsement through a single enrollment at any TSA center, with a combined fee lower than separate applications. The bill mandates coordinated expiration dates for all credentials and ensures state-issued commercial driver's licenses reflect the correct HAZMAT endorsement validity. These changes aim to reduce duplication and costs for workers needing multiple security clearances. The TSA must implement these changes within two years and publish details online.