Medicare
US Congress 116th Congress
A bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information. [S.801]
Allows certain payment information relating to covered drugs under the Medicare prescription drug benefit and Medicaid to be disclosed to additional entities. Specifically, certain subsidy and rebate information, as reported by prescription drug plan sponsors and drug manufacturers, may be disclosed to the Medicare Payment Advisory Commission and the Medicaid and Children's Health Insurance Program (CHIP) Payment and Access Commission, in accordance with specified confidentiality restrictions.
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Telehealth Innovation and Improvement Act of 2019 [S.773]
Establishes (1) a telehealth service model, and (2) Medicare payment rules with respect to certain services tested under the model. The Centers for Medicare & Medicaid Services (CMS) shall test Medicare coverage of expanded telehealth services, as defined by the bill, in conjunction with existing models that test the use of accountable care organizations, bundled payments, and other coordinated care models under Medicare. The CMS must (1) establish a methodology for determining the amounts of payment for such services, and (2) provide for evaluations
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Improving Access to Mental Health Act of 2019 [S.782]
Increases the Medicare reimbursement rate for clinical social worker services. The bill excludes clinical social worker services from the prospective payment system in which predetermined amounts form the basis for payment under Medicare. Additionally, the bill alters the definition of clinical social worker services as it relates to Medicare. Under current law, such services (1) include services performed for the diagnosis and treatment of mental illnesses, and (2) exclude services furnished to an inpatient of a skilled nursing facility as a condition
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Improving Access to Medicare Coverage Act of 2019 [HB-1682]
Deems an individual receiving outpatient observation services in a hospital as an inpatient for purposes of satisfying the three-day inpatient hospital-stay requirement with respect to Medicare coverage of skilled nursing facility services.
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Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act of 2019 [S.758]
Requires coverage for abortion care through public health insurance programs, including Medicaid, Medicare, and the Children’s Health Insurance Program, as well as insurance plans for federal employees. Further, abortion care must be available at federal, and federally supported, health care facilities to individuals eligible for services at such facilities.Additionally, the bill prohibits federal, state, or local governments from restricting coverage for abortion care available through private health insurance plans.
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Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act of 2019 [HB-1692]
Requires coverage for abortion care through public health insurance programs, including Medicaid, Medicare, and the Children’s Health Insurance Program, as well as insurance plans for federal employees. Further, abortion care must be available at federal, and federally supported, health care facilities to individuals eligible for services at such facilities.Additionally, the bill prohibits federal, state, or local governments from restricting coverage for abortion care available through private health insurance plans.
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Improving Access to Medicare Coverage Act of 2019 [S.753]
Deems an individual receiving outpatient observation services in a hospital as an inpatient for purposes of satisfying the three-day inpatient hospital-stay requirement with respect to Medicare coverage of skilled nursing facility services.
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Seniors’ Health Care Choice Act of 2019 [HB-1657]
Creates a special Medicare enrollment period for individuals enrolled in, or transitioning out of, continuation coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA)—a federal law that allows an individual to maintain health coverage following loss of coverage due to termination of employment or another qualifying event.
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Medicare Extra Rx HELP Act of 2019 Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 [S.691]
Expands eligibility for certain premium subsidies for low-income beneficiaries under the Medicare prescription drug benefit. Specifically, the bill raises the maximum allowable income for beneficiaries to qualify from 135% to 200% of the federal poverty line.
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Prescription Drug Pricing Dashboard Act [S.709]
Requires the Department of Health and Human Services to establish an online dashboard containing information about the prices and utilization of prescription drugs that are purchased by federal programs. The dashboard must include specified information, including spending per dosage, the number of drug recipients, and out-of-pocket costs. The dashboard must also highlight those drugs that have the highest spending and costs.
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Outpatient Mental Health Modernization Act of 2019 [HB-1564]
Includes nutritional planning, meals, and transportation, as well as vocational and employment counseling services, as covered partial-hospitalization services under Medicare. The Department of Health and Human Services shall convene a Behavioral Health Advisory Committee to address specified issues, including discrimination against the chronically mentally ill, elderly, and veterans in relation to treatment for mental illness.
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Removing Barriers to Colorectal Cancer Screening Act of 2019 [S.668]
Waives Medicare coinsurance requirements with respect to colorectal cancer screening tests, regardless of the code billed for a resulting diagnosis or procedure.
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Removing Barriers to Colorectal Cancer Screening Act of 2020 [HB-1570]
Modifies cost-sharing requirements for colorectal cancer screening tests, and drug manufacturer reporting requirements, under Medicare medical services. Specifically, the bill waives coinsurance requirements with respect to colorectal cancer screening tests, regardless of the code billed for a resulting diagnosis or procedure. The bill phases in implementation over an eight-year period. Additionally, manufacturers of covered drugs that do not have rebate agreements under the Medicaid Drug Rebate Program must report similar information as is required
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Improving Access to Mental Health Act [HB-1533]
Increases the Medicare reimbursement rate for clinical social worker services. The bill excludes clinical social worker services from the prospective payment system in which predetermined amounts form the basis for payment under Medicare. Additionally, the bill alters the definition of clinical social worker services as it relates to Medicare. Under current law, such services (1) include services performed for the diagnosis and treatment of mental illnesses, and (2) exclude services furnished to an inpatient of a skilled nursing facility as a condition
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Medicare Hearing Aid Coverage Act of 2019 [HB-1518]
Expands Medicare coverage to include hearing aids and related examinations. The Government Accountability Office must study programs that provide assistance for hearing aids and related examinations for individuals with hearing loss.
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Treat and Reduce Obesity Act of 2019 [HB-1530]
Expands Medicare coverage of intensive behavioral therapy for obesity. Specifically, the bill allows coverage for therapy that is provided by (1) a physician who is not a primary care physician; or (2) other health care providers (e.g., physician assistants and nurse practitioners) and approved counseling programs, if provided upon a referral from, and in coordination with, a physician or primary care practitioner. Currently, such therapy is covered only if provided by a primary care practitioner. The bill also allows coverage under Medicare's prescription
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Phair Pricing Act of 2019 [S.640]
Requires that certain negotiated prices for covered drugs under the Medicare prescription drug benefit be disclosed at the point-of-sale. Specifically, negotiated prices offered under a prescription drug plan (PDP) must be disclosed at the point-of-sale; the disclosed price must include specified adjustments, payments, and fees that are negotiated with the pharmacy (e.g., dispensing fees) by the PDP sponsor or pharmacy benefit manager. Additionally, the Centers for Medicare & Medicaid Services must establish certain quality measures for PDP sponsors
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Preserving Rehabilitation Innovation Centers Act of 2019 [S.594]
Directs the Centers for Medicare & Medicaid Services to publish and biennially update a list of all rehabilitation innovation centers. The bill defines rehabilitation innovation centers as nonprofit or government-owned rehabilitation facilities that (1) hold specified federal research and training designations for traumatic brain injury, spinal cord injury, or stroke rehabilitation research; and (2) serve at least a certain number of Medicare patients. The Medicare Payment Advisory Commission must analyze the three most recent years of cost report
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Medicare Choices Empowerment and Protection Act [S.618]
Establishes a Medicare Advance Directive Certification Program. Under the program, the Centers for Medicare & Medicaid Services (CMS) shall grant accreditation to advance directive vendors that meet specified accreditation criteria. The CMS shall establish procedures for an eligible beneficiary to register the adoption of a certified advance directive under the program. Beneficiary registration in the program shall be optional, but each eligible beneficiary who adopts and registers a certified advance directive shall receive a one-time incentive
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Default Prevention Act [S.623]
Requires the following obligations to be granted priority over all other U.S. obligations if the public debt reaches the statutory limit principal and interest on debt held by the public; compensation, allowances, and benefits for members of the Armed Forces on active duty; Social Security benefits; Medicare benefits; and obligations under any program administered by the Department of Veterans Affairs. If Congress is notified, the Department of the Treasury may issue additional debt for the priority obligations in excess of the debt limit. Treasury
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