This bill directs the Centers for Medicare & Medicaid Services to test a new payment model that allows blood transfusions for hospice patients to be billed separately from the standard daily hospice rate. Under this proposed change, Medicare would reimburse these transfusions at the same rate used when they are provided outside of a hospice setting. The legislation requires the agency to evaluate the model by comparing patient outcomes, such as hospital visits and chemotherapy use, between those receiving the new payment structure and similar patients under the current system. This initiative aims to determine if separating the payment for blood transfusions impacts care delivery and resource utilization for individuals receiving end-of-life care.
The Medicare Advantage MLR Transparency Act requires insurance companies offering Medicare Advantage plans to publicly disclose detailed financial data starting in 2029. Under this bill, each plan must report how much total revenue it collects and specifically how much is spent on actual medical claims versus administrative overhead costs. The law also mandates that this financial information be presented in a consumer-friendly format and aligns the way benefits are displayed with standards used by other health insurance plans. These changes aim to give Medicare beneficiaries clearer insight into how their premiums are utilized by the plans they choose.
This bill requires hospitals, laboratories, imaging centers, and ambulatory surgical centers to publicly post detailed price lists for their services, including standard charges, negotiated rates, and discounted cash prices, starting in 2027. It also mandates that private health insurance plans provide consumers with cost-sharing estimates and publish quarterly data on payment rates to doctors and pharmacies beginning in 2029. Additionally, the legislation requires Medicare Advantage and prescription drug plan sponsors to report ownership details for providers and pharmacies they control, while establishing civil penalties for entities that fail to comply with these transparency rules.
The Medicare Access to Rural Anesthesiology Act changes how Medicare pays for anesthesia services at specific small rural hospitals and critical access hospitals. To qualify for these changes, a hospital must be located in a rural area, have fewer than 800 surgeries requiring anesthesia, and employ or contract with no more than one full-time anesthesiologist who agrees not to bill Medicare separately for those services. Once a hospital meets these criteria, anesthesia care provided by an anesthesiologist there will be paid based on the hospital's actual costs rather than a fixed fee, and it will be classified as part of the hospital's inpatient services instead of a separate billable service. The law also requires the Department of Health and Human Services to update its regulations to reflect these new payment rules.
The Save MEDICARE Act of 2026 aims to improve the Medicare Advantage program by starting in 2028 with several changes to how health plans are paid and monitored. It requires the government to exclude diagnoses from chart reviews when calculating payments to prevent plans from inflating costs based on questionable data. The bill also speeds up audits and appeals to ensure faster resolution of coding disputes and introduces a new penalty system to recover overpayments from plans. Additionally, the law allows states to enforce Medicare rules within their borders and bans financial incentives for doctors based on how they code patient records. Finally, it establishes a mechanism for the Department of Veterans Affairs to recover costs when Medicare Advantage plans cover care that should have been paid for by the VA.
The No Medicare Clawbacks Act of 2026 prevents group health plans from taking back money they have already paid for medical services if a patient later becomes eligible for Medicare benefits. This rule applies specifically when the medical care was provided during a period of retroactive Medicare coverage and the patient was current on their required health plan contributions at the time of service. By amending the Social Security Act, the bill ensures that individuals do not face financial penalties for receiving care before their Medicare eligibility is officially recognized. The legislation directly affects employers offering group health plans and their employees who might otherwise face recouped payments due to delayed Medicare enrollment.
The Residential Recovery for Seniors Act expands Medicare coverage to include three specific levels of residential treatment for substance use disorders: clinically managed low-intensity, clinically managed high-intensity, and medically managed services. To qualify for this coverage, facilities must meet strict standards regarding staffing, clinical assessments, and adherence to evidence-based criteria developed by recognized medical associations. The bill also establishes a new payment system that reimburses these facilities on a per-day basis, starting in fiscal year 2027, with rates initially set to cover 100% of their estimated costs.
This resolution expresses the sense of Congress that Medicaid is a vital lifeline for the health care of millions of Americans, including older adults, people with disabilities, and low-income families. It highlights concerns that recent legislation will cut funding and impose new eligibility rules and paperwork requirements, which could negatively impact access to care. While the bill itself does not change laws or allocate money, it urges the Centers for Medicare & Medicaid Services to provide immediate guidance to state agencies and enrollees regarding these upcoming changes.
The Kidney Disease Education Access Expansion Act of 2026 expands Medicare coverage to include kidney disease education services for individuals with hypertension, diabetes, or any stage of chronic kidney disease, rather than limiting them to those with advanced disease. This bill broadens the range of eligible providers to include community health workers and clinical social workers, allows these services to be delivered in group settings or with caregivers present, and adds new topics such as transition assistance for transplant recipients. Starting in 2027, the law also requires private health insurance plans to cover these education services and establishes a working group to develop methods for measuring the effectiveness of the program.
This bill requires the Department of Veterans Affairs to create a data-sharing agreement with the Department of Health and Human Services to prevent duplicate or incorrect medical billing for veterans. Under this arrangement, the two agencies would exchange information about veterans who are enrolled in both the VA system and Medicare, Medicaid, or Medicare Advantage plans to identify and stop improper payments. The agreement would last for two years, and the VA must report to Congress on how effective the data sharing is at reducing billing errors.
