The Mamas First Act aims to reduce maternal mortality rates by expanding Medicaid coverage to include support services from doulas, midwives, tribal midwives, and lactation providers. This legislation modifies the Social Security Act to allow these professionals to bill Medicaid for prenatal, labor, and postpartum care delivered in various settings, including homes, hospitals, and clinics. To qualify for reimbursement, doulas must hold a certification requiring continuing education and gather specific client or provider recommendations, while midwives and lactation support providers must meet defined state or international standards. The bill also prohibits Medicaid programs from charging copayments or deductibles for these essential services, with the changes taking effect on January 1, 2027.
The SECURE 340B Act strengthens oversight of the drug discount program for safety-net health care providers by establishing clearer definitions for patients and prescribing providers, requiring detailed record-keeping to prove a legitimate patient relationship. The bill introduces strict rules for contract pharmacies, mandating that manufacturers cannot restrict discounts based on their use and requiring full transparency on where these drugs are dispensed. It also expands eligibility for child sites of covered entities while imposing a new community need standard based on geographic vulnerability scores to prevent abuse. To improve program integrity, the legislation creates a centralized data clearinghouse to track claims and prevent duplicate discounts, while simultaneously prohibiting discriminatory practices by insurance companies and pharmacy benefit managers against covered entities. Finally, the Act authorizes new user fees and additional funding for the Health Resources and Services Administration to support expanded audits and enforcement activities.
The Medicare Advantage Supplemental Benefits Transparency Act of 2026 requires Medicare Advantage plans to submit detailed data on supplemental benefits to the federal government starting in 2029. This information will include specific details about what benefits are offered, eligibility rules, and how much each enrollee spends on these services. The Centers for Medicare & Medicaid Services will then make this de-identified data available to the public and researchers for analysis after a two-year delay. To support the implementation of these reporting requirements, the bill appropriates $12 million for fiscal year 2026.
The Health Claim Denial Transparency Act requires group health plans to include detailed data in their annual reports, specifically detailing the number of claims submitted, approved, denied, and appealed. This reporting covers various claim types, including prescription drugs, mental health services, cancer treatments, and those processed using artificial intelligence, while also specifying the reasons for denials such as lack of prior authorization or medical necessity. The law applies to plans with fewer than 100 participants and includes an exception for small plans that handle very few specific types of claims to avoid excessive administrative burdens. By mandating this disclosure, the bill aims to increase visibility into how health plans process and reject medical benefit requests.
The Nitrous Oxide Inhalation Prevention Act establishes new federal regulations to curb the misuse of nitrous oxide while allowing its continued use for legitimate medical, industrial, and automotive purposes. Key provisions include banning flavored products and limiting food-use canisters to 8 grams, alongside strict rules that prohibit packaging with bright colors or cartoon characters and require prominent warning labels on every cartridge. The bill also imposes age restrictions by setting a minimum purchase age of 21, mandates that retailers verify identification and limit sales hours, and restricts wholesalers from selling directly to individual consumers. To support harm reduction efforts, the legislation authorizes funding for grants aimed at education, prevention programs, and training for law enforcement and medical professionals. Non-compliance with these new requirements can result in civil monetary penalties for manufacturers and distributors, or escalating fines and potential sales bans for retailers.
The POPCaP Act of 2026 establishes a precision oncology program within the Department of Veterans Affairs specifically for veterans diagnosed with prostate cancer. To deliver this care, the bill designates 21 existing VA medical centers across the country as provisional centers of excellence, requiring each to perform genetic sequencing, participate in clinical trials, and maintain specific staffing levels including oncologists and researchers. These centers will operate under a centralized leadership team that coordinates research activities, manages a national data registry, and ensures veterans have access to the latest biomarker-specific treatments. The legislation authorizes $15.5 million annually for fiscal years 2027 through 2029 to fund the program and mandates annual reports to Congress detailing patient outcomes and research progress.
The Outpatient Surgery Access Act of 2026 changes how Medicare calculates payment updates for ambulatory surgical centers starting in 2027. It requires the Centers for Medicare & Medicaid Services to use the same annual price increase factors applied to other outpatient services, rather than a separate calculation. Additionally, the bill removes a specific rule that previously limited these payment updates to keep total spending flat, allowing for more consistent price adjustments. These changes directly affect hospitals and clinics that perform surgeries on an outpatient basis and the patients who receive those services under Medicare.
The Turn the Tide Act primarily increases federal funding for substance use disorder treatment, prevention, and recovery services, directing billions of dollars to states, tribes, and local organizations for the years 2027 through 2030. Key provisions include expanding Medicaid coverage for mental health and behavioral health services, removing insurance barriers to medication-assisted treatment, and limiting cost-sharing requirements for opioid overdose reversal medications. The bill also establishes new grant programs to support recovery housing, train first responders, and assist law enforcement with mental health and wellness initiatives. Additionally, it targets funding toward states with the highest rates of drug overdose deaths and extends existing waivers to improve Medicaid delivery systems in those areas.
The Protecting Patients from Automated Denials Act requires Medicare Advantage plans to ensure that any denial of medical coverage based on artificial intelligence is reviewed and approved by a qualified physician before it is issued. This rule, which applies to plan years starting on or after January 1, 2027, mandates that the reviewing doctor must exercise independent medical judgment and provide a signed statement confirming the denial was not generated by AI. Additionally, the plan must inform the patient and provider that AI was used, share the doctor's contact information, and keep detailed records of the process for at least 10 years. The legislation also establishes a system for the government to audit these plans and requires them to submit regular reports on how often AI is used to deny care.
The Expanding Opportunities for Recovery Act of 2026 directs federal funding to states to improve access to opioid addiction treatment for individuals who lack health insurance or face coverage barriers. These grants must be managed by state substance abuse agencies and used to provide evidence-based services, such as medication-assisted treatment, based on medical recommendations. The legislation explicitly limits grant funds to cover no more than 60 consecutive days of treatment per person and requires states to report data on treatment outcomes and usage. Additionally, the bill mandates that the federal government evaluate the program's effectiveness and share results publicly while offering technical assistance to participating states.
