Medicare
US Congress 116th Congress
Medicare-X Choice Act of 2019 [S.981]
Establishes and funds the Medicare Exchange health plan, which allows individuals who are not otherwise eligible for Medicare to enroll in a government-administered health insurance plan. The Centers for Medicare & Medicaid Services (CMS) must offer such plan in certain individual health insurance exchanges beginning plan year 2021 and offer it in all individual health insurance exchanges beginning plan year 2024. CMS must offer the plan in the small group market in all geographic areas for plan year 2025. The plan must meet the same requirements,
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Medicare Care Coordination Improvement Act of 2019 [S.966]
Exempts certain alternative payment models under Medicare from the general prohibition on physician self-referrals (i.e., the Stark law).
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Medicare for All Act of 2019 [S.1129]
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
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Concentrating on High-value Alzheimer’s Needs to Get to an End (CHANGE) Act of 2019 [S.1126]
Modifies the requirements under Medicare for diagnosing and treating Alzheimer's disease and other cognitive impairments in older adults. Specifically, the bill expands the cognitive impairment detection benefit during annual wellness visits to require the use of validated detection tools and documentation of the results in the patient's medical record. Further, when a cognitive impairment is detected, the patient must be referred to an appropriate diagnostic service provider and other specified supports.Additionally, the Centers for Medicare and
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HELLPP Act Helping Ensure Life- and Limb-Saving Access to Podiatric Physicians Act [HB-2235]
Adds podiatrists as covered physicians under the Medicaid program. Additionally, the bill revises certain documentation requirements related to Medicare coverage of therapeutic shoes for individuals with diabetes. Finally, the bill subjects payments made to a Medicaid provider or supplier to a continuing levy for federal taxes owed by the provider or supplier.
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Medicare Care Coordination Improvement Act of 2019 [HB-2282]
Exempts certain alternative payment models under Medicare from the general prohibition on physician self-referrals (i.e., the Stark law).
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CHANGE Act of 2019 Concentrating on High-value Alzheimer’s Needs to Get to an End Act of 2019 [HB-2283]
Modifies the requirements under Medicare for diagnosing and treating Alzheimer's disease and other cognitive impairments in older adults. Specifically, the bill expands the cognitive impairment detection benefit during annual wellness visits to require the use of validated detection tools and documentation of the results in the patient's medical record. Further, when a cognitive impairment is detected, the patient must be referred to an appropriate diagnostic service provider and other specified supports.Additionally, the Centers for Medicare and
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Medicare Advantage Quality Payment Relief Act of 2019 [S.1114]
Requires the Centers for Medicare & Medicaid Services to disregard the application of certain percentage quality increases when calculating the maximum payment that may be made to a Medicare Advantage organization.
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PIMA of 2019 Promoting Integrity in Medicare Act of 2019 [HB-2143]
Expands Medicare's prohibition on physician self-referrals (i.e., the Stark law) to include, with specified exceptions, certain advanced imaging, anatomic pathology, radiation therapy, and physical therapy services. Additionally, the bill establishes increased civil monetary penalties for violations of the self-referral prohibition with respect to those services. The Centers for Medicare & Medicaid Services shall conduct a compliance review with respect to such referrals.
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To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals. [HB-2172]
Establishes a Federal Medical Assistance Percentage of 100% with respect to a U.S. territory's use of specified federal funds to provide covered drugs to low-income individuals who are eligible for the Medicare prescription drug benefit.
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To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals. [HB-2172]
Establishes a Federal Medical Assistance Percentage of 100% with respect to a U.S. territory's use of specified federal funds to provide covered drugs to low-income individuals who are eligible for the Medicare prescription drug benefit.
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Metastatic Breast Cancer Access to Care Act [HB-2178]
Exempts individuals with metastatic breast cancer from certain waiting periods for disability insurance benefits under the Old-Age, Survivors, and Disability Insurance program and related Medicare coverage.
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Home Health Care Planning Improvement Act of 2019 [HB-2150]
Allows Medicare payment for home health services ordered by a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant. Currently, coverage is provided only for services ordered by a physician.
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Proposing a balanced budget amendment to the Constitution of the United States. [HJR-55]
This joint resolution proposes a constitutional amendment prohibiting total outlays for a fiscal year from exceeding total receipts for that fiscal year unless Congress authorizes the excess by a three-fifths roll call vote of each chamber. The prohibition excludes outlays for repayment of debt principal, receipts derived from borrowing, and receipts or outlays of the Social Security and Medicare trust funds. The amendment requires the President to annually submit to Congress a budget in which total outlays do not exceed total receipts. The amendment
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Medicare Advantage Quality Payment Relief Act of 2019 [HB-2131]
Requires the Centers for Medicare & Medicaid Services to disregard the application of certain percentage quality increases when calculating the maximum payment that may be made to a Medicare Advantage organization.
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Prescription Drug STAR Act Prescription Drug Sunshine, Transparency, Accountability and Reporting Act [HB-2113]
Establishes requirements for prescription drug manufacturers to provide certain information about pricing, discounts, and product samples of applicable drugs. Specifically, the bill requires the Department of Health and Human Services (HHS) to annually determine whether there are price increases of a certain threshold for outpatient prescription drugs covered under Medicare, excluding low-cost drugs.Manufacturers must provide HHS with an explanation for drug prices that (1) cumulatively increase by at least 10% or $10,000 over one year; (2) cumulatively
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Removing Barriers to Allergy Diagnostic Testing Act of 2019 [HB-2009]
Requires equal coverage of two types of allergy tests under Medicaid and Medicare. Specifically, in vitro specific IgE tests (blood tests) and percutaneous tests (skin tests) must be treated equally with respect to (1) medical necessity or other coverage requirements, (2) frequency limits, and (3) allergen unit limits.
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Medicare-X Choice Act of 2019 [HB-2000]
Establishes and funds the Medicare Exchange health plan, which allows individuals who are not otherwise eligible for Medicare to enroll in a government-administered health insurance plan. The Centers for Medicare & Medicaid Services (CMS) must offer such plan in certain individual health insurance exchanges beginning plan year 2021 and offer it in all individual health insurance exchanges beginning plan year 2024. CMS must offer the plan in the small group market in all geographic areas for plan year 2025. The plan must meet the same requirements,
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Rural Health Clinic Modernization Act of 2019 [S.1037]
Makes a series of changes to criteria, requirements, and payments for rural health clinics under Medicare. Among other things, the bill (1) allows rural health clinics that are not directed by physicians to enter into arrangements with physician assistants or nurse practitioners that generally comply with state laws (regarding scope of practice), rather than other specific requirements; (2) allows rural health clinics to serve as the distant site for purposes of telehealth services; and (3) beginning in 2020, increases the maximum payment rate per
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CHOICE Act Consumer Health Options and Insurance Competition Enhancement Act [S.1033]
Requires the Centers for Medicare and Medicaid Services (CMS) to develop a public health insurance option that meets all federal plan requirements and is available on state and federal health insurance exchanges. Specifically, the CMS must offer silver and gold plans, may offer bronze plans, and must include all essential benefits, consumer protections, and cost-sharing limitations in each plan.The CMS may contract with a third party to administer the public option plans and states may establish advisory councils to make recommendations to the CMS
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