Rep. Mark Pocan

Maddy summaryThe STAR Plus Scholarship Act creates a federal program to fund scholarships for students pursuing careers in mental health and substance use disorder treatment. It requires scholarship recipients to work full-time in designated mental health professional shortage areas for one year for each year of scholarship funding received. The program authorizes $75 million annually (2025-2029) to cover tuition and educational expenses for students enrolled in approved programs at accredited institutions. This directly affects students in behavioral health fields and aims to address workforce shortages in underserved communities by linking scholarship support to service requirements.

Maddy summaryHR 9152, the "SCHOOL Professionals Act of 2024," clarifies that contractors primarily providing operations or logistics services to educational organizations must be treated like direct employees for health coverage purposes under federal tax law. This means educational institutions using such contractors must determine if these workers qualify as "full-time" for health insurance requirements, similar to their own employees. The bill directly affects schools and colleges that rely on external contractors for facility or support services, requiring them to apply the same full-time employee rules to these contractors when assessing health coverage obligations. The rule change applies to months beginning after the bill's enactment date.

Maddy summaryThe Health Over Wealth Act requires private equity firms that own or control health care entities (including hospitals, clinics, nursing facilities, and mental health providers) to submit detailed annual reports to the government about their financial structure, staffing practices, political spending, and patient care metrics. It establishes a task force to monitor private equity's impact on health care access and quality, and creates new requirements for hospitals planning to close or discontinue services, including advance notice and mitigation plans. The bill also prohibits certain real estate transactions that could weaken health care entities and mandates licensing for private equity firms investing in health care, with penalties for non-compliance.

Maddy summaryThe Pharmacists Fight Back Act (HR 9096) sets new rules for Pharmacy Benefits Managers (PBMs) working with federal health care programs like Medicare Part D and Medicaid. It requires PBMs to reimburse in-network pharmacies at a rate covering the drug's actual cost plus a small fee (capped at $25), and to reduce patient cost-sharing by at least 80% of rebates received from drug manufacturers. The bill bans PBMs from steering patients to specific pharmacies, charging patients more than pharmacies are paid, or using rebates to lower pharmacy payments after claims are processed. It also mandates public reporting of drug pricing data to improve transparency, ensuring patients and pharmacies receive fairer treatment under federal health programs.

Maddy summaryHR 8796, the "Stop Comstock Act," removes outdated restrictions from federal law that previously banned the distribution of materials related to contraception and abortion as "obscene" or "indecent." The bill amends Title 18 and the Tariff Act by deleting references to "indecent," "immoral," "unlawful abortion," and "procuring abortion" from provisions governing obscene materials. It clarifies that the law only prohibits "obscene materials" in commerce, eliminating broad restrictions on reproductive health information. This directly affects internet platforms, healthcare providers, and individuals sharing reproductive health resources by removing legal barriers to their distribution.

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 summaryHR 8390, the Mental Health and MAMA Act of 2024, eliminates cost-sharing (like copays or deductibles) for mental health and substance use disorder services during pregnancy and for one year after birth. It applies to people enrolled in group health plans, individual insurance, or federal employee health plans, covering services provided by in-network providers. The bill requires insurers to waive these costs starting two years after enactment, explicitly including telehealth services. It specifically targets care for pregnant and postpartum individuals, ensuring coverage from pregnancy diagnosis through the 12 months following birth.

Maddy summaryThe Essential Caregivers Act of 2024 requires nursing homes and similar facilities to allow residents to designate essential caregivers who provide emotional support or assistance with daily activities. During emergencies when regular visitation is restricted, facilities must permit at least one essential caregiver access to residents daily and cannot deny access without following specific procedures. Facilities may deny access for a maximum of 7 days during emergencies (or 14 days with state approval), and must provide a written explanation and appeal process if access is denied. The bill establishes a 48-hour appeal process for residents and caregivers to challenge denials, with facilities required to prove violations during appeals. This law applies to Medicare skilled nursing facilities, Medicaid nursing facilities, intermediate care facilities, and certain inpatient rehabilitation facilities.

Maddy summaryHR 7641, the Justice for Patients Act, prohibits health insurance plans and issuers from requiring patients to use pre-dispute arbitration or blocking class-action lawsuits for coverage-related claims. It directly affects all patients with group or individual health insurance plans and the insurance companies offering those plans. The bill bans two specific contract terms: mandatory arbitration clauses for health coverage disputes and limitations on class actions for plan administration issues. If enacted, these provisions would be unenforceable under federal law, ensuring patients retain their right to pursue legal action in court.

Maddy summaryThis bill requires Medicare to cover falls risk assessments and fall prevention services during annual wellness visits and initial preventive physical exams for seniors aged 65+ who have fallen in the previous year. It directly affects Medicare beneficiaries with recent falls and healthcare providers delivering these services under Medicare. The key mechanism expands existing Medicare benefits to include these specific fall prevention services, effective January 1, 2025. Additionally, it mandates annual reports starting in 2026 tracking falls data for seniors over 65 who received fall-related treatment.