This bill establishes a minimum reimbursement standard for pharmacies that are not classified as critical access care facilities, requiring Medicaid managed care organizations to pay at least the same rates as the traditional fee-for-service program. The law mandates that these payments cover both the professional dispensing fee and the acquisition cost of the medication, regardless of whether the managed care organization pays the pharmacy directly or uses a third-party pharmacy benefit manager. Additionally, the bill directs the state Department of Healthcare Finance to implement various cost-control measures, such as limiting the number of prescriptions for certain drugs within a 30-day period and requiring prior approval for specific high-cost medications.
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 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 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 Mamas First Act expands Medicaid coverage to include prenatal, labor, and postpartum care provided by doulas, midwives, tribal midwives, and lactation support providers. To qualify for this coverage, these professionals must meet specific certification, training, or recognition standards, such as doulas having continuing education and references from former clients or healthcare providers. The bill also prohibits Medicaid programs from charging copayments or deductibles for these essential services. These changes are scheduled to take effect on January 1, 2027, aiming to improve maternal health outcomes by increasing access to supportive care.
The Drug Deal Disclosure Act requires the Department of Health and Human Services to publicly release records of specific agreements between the federal government and major drug manufacturers starting in 2025. These agreements must include provisions such as offering lower drug prices based on international rates, providing discounts through government platforms like TrumpRx, or receiving special exemptions from import duties and regulatory reviews. While the bill mandates that most documents be made available in a searchable format, it allows the government to withhold only specific confidential pricing details if legally required by foreign laws or court orders, provided a justification is published. Additionally, the law directs the Congressional Budget Office and the Government Accountability Office to analyze the economic and budgetary impacts of these deals, including effects on Medicare, Medicaid, and drug competition.
The Expand the Behavioral Health Workforce Now Act directs the Secretary of Health and Human Services to issue guidance to states within 12 months of enactment. This guidance will outline strategies to improve the education, training, recruitment, and retention of mental health and substance use disorder care providers participating in Medicaid and CHIP programs. A specific focus of these strategies is to enhance the capacity of the workforce in rural and underserved areas. The act also specifies that the guidance should explore how states can use existing federal waivers and authorities to achieve these workforce goals.
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 Protecting Americans' Health Care Act of 2026 reverses specific Medicaid changes made in the 119th Congress. It directly affects state and federal health programs by restoring the original rules that were previously altered. The bill achieves this by repealing the relevant sections of the reconciliation law and reinstating the prior legislation as if the changes had never occurred. This action effectively undoes the policy shifts related to Medicaid funding and eligibility that were implemented in the earlier session.
