This bill requires Medicare Advantage (MA) plans to maintain accurate, publicly accessible provider directories containing essential details like provider names, specialties, contact information, and accessibility features. MA organizations must verify directory accuracy quarterly (or annually for hospitals), remove outdated providers within 5 business days, and clearly flag outdated information. If a beneficiary relies on an incorrect directory listing for a non-participating provider, the MA plan must cover the same cost-sharing as if the provider were in-network. These requirements apply to all network-based MA plans starting in 2026, with annual accuracy reports and public score disclosures beginning in 2027.
The EPCS 2.0 Act (HR 7312) requires group health plans and health insurance issuers to implement policies mandating electronic prescriptions for schedule II-V controlled substances by January 1, 2026. The bill includes 18 specific exceptions to this requirement, such as when providers and pharmacies are the same entity, for research protocols, or due to technological limitations preventing electronic transmission. It prohibits requiring specific electronic prescribing vendors and mandates annual compliance attestations from health plans starting in 2026. This legislation applies to prescriptions transmitted by participating providers for health plan members and beneficiaries. The bill aims to modernize prescription practices while maintaining flexibility for healthcare providers and patients.
This bill requires Medicare to provide clear outreach and education so Medicare beneficiaries (enrolled in Part A, Part B, or Medicare Advantage plans) can authorize family caregivers to access their health information via 1-800-MEDICARE. It mandates the inclusion of a specific authorization form (CMS-10106) in Medicare notices and on Medicare.gov, along with training for call center staff. The Secretary must also share best practices to prevent fraud related to caregiver access and make materials available in non-English languages. It directly affects beneficiaries, their family caregivers, healthcare providers, and Medicare call center operators.
HR 7142 (Alternatives to PAIN Act) requires Medicare Part D plans to cover non-opioid pain management drugs with no deductible and at the lowest copay level starting in 2025. It defines "qualifying non-opioid drugs" as FDA-approved medications that don’t act on opioid receptors (like certain NSAIDs or nerve pain treatments), excluding opioids and schedule I-III drugs. The bill prohibits Medicare plans from forcing patients to try opioids first (step therapy) or requiring prior approval for these non-opioid options. It directly affects Medicare beneficiaries needing pain management, especially those seeking alternatives to opioids for post-surgical or acute pain. The policy change aims to improve access to non-addictive pain treatments while preserving doctors' authority to prescribe medically appropriate care.
This bill adds 1,000 new medical residency positions (500 in 2024 and 500 across 2025-2028) specifically for training in addiction medicine, addiction psychiatry, or pain medicine. It directly affects hospitals that have or will establish approved residency programs in these fields. Hospitals receiving these positions must use them for addiction-related training for five years, with unused positions redistributed if requirements aren't met. The goal is to expand the healthcare workforce addressing the substance use disorder crisis by increasing specialized training opportunities.
The Nutrition CARE Act of 2024 expands Medicare Part B coverage to include medical nutrition therapy services for beneficiaries diagnosed with eating disorders. It directly affects Medicare beneficiaries with eating disorders - particularly an estimated 420,500-560,700 Black, Indigenous, and People of Color seniors - by requiring coverage for 13 hours of initial care (including assessment) and 4 hours annually for ongoing management. The bill amends Medicare law to specify that these services must be provided by registered dietitians or nutrition professionals following referrals from physicians or psychologists. Coverage applies to all eating disorders as defined by the DSM-5, addressing a gap where Medicare previously excluded this critical treatment component. This policy change aims to improve access to evidence-based care for a condition linked to high mortality and significant healthcare costs.
This bill, HR 6860, protects patients with end-stage kidney disease (ESRD) who require dialysis by preventing health insurance plans from discriminating against them. It amends Medicare rules to prohibit plans from treating dialysis coverage differently than other medical services based on a patient’s ESRD diagnosis, need for dialysis, or any other factor. The bill clarifies that plans can still choose which dialysis providers to include in their networks but cannot deny or limit coverage for dialysis services solely because of the patient’s condition. It ensures Medicare remains the secondary payer for these services as intended, without forcing plans to cover specific providers.
HR 6780 establishes a 4-year Medicare demonstration program testing whether hospitals providing medically tailored home-delivered meals to specific patients improves health outcomes and reduces hospital readmissions. The program targets Medicare beneficiaries with diet-sensitive chronic conditions (like diabetes or heart failure) who are at high risk of readmission and meet specific discharge criteria, such as limited daily living activities. Selected hospitals must screen patients, provide at least two tailored meals daily for 12 weeks, and offer medical nutrition therapy, all without patient cost-sharing. The program requires hospitals to submit data for evaluation, with the goal of assessing impacts on hospital admissions, care costs, and patient satisfaction before reporting to Congress in 2027 and 2030.
HR 6110, the Access to Inpatient Rehabilitation Therapy Act of 2023, would change how Medicare determines eligibility for inpatient rehabilitation therapy. It restores physicians' authority to modify a patient's therapy plan after admission to include additional medically necessary services - such as recreational or respiratory therapy - beyond the current four required therapies (physical, occupational, speech therapy, and orthotics/prosthetics). This applies to Medicare beneficiaries in inpatient rehabilitation facilities who already meet the initial requirement of needing at least two of the core therapies at admission. The change takes effect after December 31, 2023, allowing treatment teams to tailor care more flexibly based on patient needs.
The SAFE in Recovery Act protects pregnant and postpartum individuals with substance use disorders by prohibiting toxicology testing without consent and preventing child welfare investigations based solely on prescribed medications for treatment. It establishes a Federal interagency task force to coordinate services across multiple departments and allocates $500 million for community health centers to expand behavioral health services. The bill also provides $60 million annually for Head Start programs to support children from families impacted by substance use disorder. These provisions aim to improve access to care while preventing unnecessary family separations.
HR 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.
HR 5819, the COMPLETE Care Act, incentivizes Medicare primary care providers to integrate behavioral health services by increasing payments for specific services (like mental health and substance use disorder support) during 2025-2027. Providers using designated HCPCS codes for integrated care would receive 125-175% of standard payment rates, with the percentage declining annually. The bill also requires these providers to report on integration quality measures and mandates technical assistance for practices adopting integrated models, funded through new appropriations for 2024-2027. It directly affects Medicare-participating primary care practices serving beneficiaries needing mental health or substance use services.
