Healthcare (Medicare)

This bill expands Medicare coverage to include genetic counseling services provided by licensed or certified genetic counselors, effective January 1, 2027. It defines "covered genetic counseling services" as those furnished by qualified counselors under state law or certification, with payments set at 80% of the lesser of the actual charge or 85% of the physician fee schedule. Medicare beneficiaries seeking genetic counseling will gain access to these services through covered providers, while preventing balance billing for these specific services. The bill does not restrict physicians from billing for similar services under existing Medicare rules.

Increasing Access to Lung Cancer Screening Act This bill provides for coverage without prior authorization requirements of annual lung cancer screenings under Medicaid, Medicare, and private health insurance for individuals for whom screenings are recommended under U.S. Preventive Services Task Force guidelines. It also expands Medicaid coverage of counseling and pharmacotherapy for cessation of tobacco use to all individuals, rather than only pregnant women. The Department of Health and Human Services must conduct outreach on the importance of lung cancer screenings and who should be screened, and the Government Accountability Office must report on the demographics of those diagnosed with lung cancer and recommend ways the federal government can improve screenings.

This bill allows seniors over 65 who only have Medicare Part A hospital insurance (and no other Medicare coverage) to contribute to Health Savings Accounts (HSAs). Currently, Medicare beneficiaries cannot contribute to HSAs, but this bill removes that restriction for seniors enrolled solely in Part A. The change amends the tax code to exclude these individuals from the existing HSA contribution ban during periods they have only Part A coverage. The provision takes effect for tax years beginning after December 31, 2024.

This bill requires Medicare Advantage (MA) plan advertisements to disclose specific data about prior authorization denials. Starting one year after enactment, ads must include the number of denied prior authorization requests, how many were later approved after reconsideration, and the average time between denial and approval. These disclosures must cover the most recent plan year before the ad is published, using both verbal and visual methods where possible. The policy directly affects MA plan marketers and beneficiaries who view these advertisements, aiming to provide clearer information about plan coverage experiences.

Medicare for All Act This bill establishes a national health insurance program that is administered by the Department of Health and Human Services (HHS). Among other requirements, the program must (1) cover all U.S. residents; (2) provide for automatic enrollment of individuals upon birth or residency in the United States; and (3) cover items and services that are medically necessary or appropriate to maintain health or to diagnose, treat, or rehabilitate a health condition, including hospital services, prescription drugs, mental health and substance abuse treatment, dental and vision services, long-term care, gender affirming care, and reproductive care, including contraception and abortions. The bill prohibits cost-sharing (e.g., deductibles, coinsurance, and copayments) and other charges for covered services. Additionally, private health insurers and employers may only offer coverage that is supplemental to, and not duplicative of, benefits provided under the program. Health insurance exchanges and specified federal health programs terminate upon program implementation. However, the program does not affect coverage provided through the Department of Veterans Affairs or the Indian Health Service. The bill also establishes a series of implementing provisions relating to (1) health care provider participation; (2) HHS administration; and (3) payments and costs, including the requirement that HHS negotiate prices for prescription drugs. Individuals who are age 18 or younger, age 55 or older, or already enrolled in Medicare may enroll in the program starting one year after enactment of this bill; other individuals may buy into the program at this time. The program must be fully implemented two years after enactment.

This bill adds specific Medicare coverage for treatments of dialysis-related amyloidosis, a condition affecting some long-term dialysis patients. It defines these treatments as FDA-approved items/services provided in dialysis facilities, including necessary adjunct supplies. Medicare will pay 100% of reasonable charges for these treatments separately, outside standard dialysis payment bundles. This directly affects Medicare beneficiaries receiving these specific treatments at approved dialysis facilities.

The Advancing Access to Telehealth Act makes permanent Medicare's temporary telehealth flexibilities that were expanded during the public health emergency. It allows Medicare beneficiaries to receive telehealth services for mental health, stroke care, substance use disorder, and home dialysis without needing an initial in-person visit. The bill also expands eligibility for telehealth providers to include more healthcare professionals and permanently authorizes Federally Qualified Health Centers and Rural Health Clinics to offer telehealth services. Additionally, it permits audio-only telehealth calls for certain services, removing previous video-only requirements.

HR 5281, the REAL Health Providers Act, requires Medicare Advantage (MA) plans to maintain accurate, publicly accessible provider directories starting in 2028. It mandates that plans verify directory information every 90 days (or annually for hospitals), flag outdated entries, and remove providers no longer in-network within 5 business days. The bill also ensures Medicare beneficiaries are not charged extra for services from providers listed in directories but not actually in-network, covering the difference between in-network and out-of-network cost-sharing. MA plans must report annual accuracy scores to Medicare, which will be published online starting in 2029, with $4 million allocated for implementation. This directly affects MA organizations and beneficiaries by improving access to reliable provider information and reducing unexpected costs.

This bill prohibits Medicare from paying for orthotics or prosthetics delivered directly to patients without in-person training from a qualified provider (a "drop shipment"), ensuring beneficiaries receive proper fitting and use instructions. It expands the list of healthcare providers who can prescribe these devices to include physical therapists, occupational therapists, orthotists, and prosthetists. The bill also specifically requires Medicare to cover replacements for custom-fitted orthotics and custom-fabricated orthotic devices, aligning with existing rules for prosthetic replacements. These changes aim to improve patient safety and access to properly fitted devices under Medicare.

This bill expands Medicare's definition of "rural emergency hospital" to allow certain closed rural hospitals to rejoin the program. Specifically, it creates a new eligibility category for facilities that were critical access hospitals or rural hospitals (under Section 1886(d)) in rural counties, ceased operations between January 2014 and December 2020, and submit an application to become rural emergency hospitals. The bill modifies Medicare payment rules to provide specific adjustments for these reactivated facilities, including distance requirements (e.g., hospitals within 35 miles of another hospital won't receive immediate payment increases). The changes take effect January 1, 2027, directly affecting rural hospitals that closed during the specified period and wish to rejoin Medicare.