Medicare
US Congress 116th Congress
Lymphedema Treatment Act [S.518]
Includes certain lymphedema compression treatment items as covered durable medical equipment under Medicare. (Lymphedema is a condition of localized fluid retention and tissue swelling that is caused when the lymphatic system is damaged or blocked.)
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State Public Option Act [S.489]
Allows residents who are not already eligible for Medicaid and not concurrently enrolled in other health insurance coverage to buy into a state Medicaid plan beginning January 1, 2020, at the option of the state. State Medicaid programs may set premiums and cost-sharing requirements for such coverage in accordance with specified limitations. The bill also (1) provides the enhanced Federal Medical Assistance Percentage (FMAP) to every state that expands Medicaid coverage for individuals who are newly eligible under the Patient Protection and Affordable
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State Public Option Act [HB-1277]
Allows residents who are not already eligible for Medicaid and not concurrently enrolled in other health insurance coverage to buy into a state Medicaid plan beginning January 1, 2020, at the option of the state. State Medicaid programs may set premiums and cost-sharing requirements for such coverage in accordance with specified limitations. The bill also (1) provides the enhanced Federal Medical Assistance Percentage (FMAP) to every state that expands Medicaid coverage for individuals who are newly eligible under the Patient Protection and Affordable
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Payment Commission Data Act of 2019 [HB-1264]
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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Creating Transparency to Have Drug Rebates Unlocked (C–THRU) Act of 2019 [S.476]
Establishes a series of requirements relating to drug rebates and discounts under Medicare and Medicare Advantage (MA). Specifically, for each pharmacy benefits manager (PBM) that contracts with a prescription drug plan (PDP) under Medicare or MA, or with a qualified health benefits plan offered through a health insurance exchange, HHS must publish on its website (1) the amount and type of rebates and discounts negotiated by the PBM and the extent to which these rebates and discounts are passed on to the plan sponsor, and (2) the difference between
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Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2019 RxCAP Act of 2019 [S.475]
Eliminates beneficiary cost-sharing above the Medicare prescription drug benefit's annual out-of-pocket threshold beginning in plan year 2020. Under current law, the Medicare prescription drug benefit provides coverage above that threshold only with cost-sharing in the form of either copayment or coinsurance.
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Medicare at 50 Act [S.470]
Establishes a Medicare buy-in option for certain qualifying individuals and also repeals restrictions relating to prescription drug prices under the Medicare prescription drug benefit. Specifically, the bill allows individuals aged 50 to 64 to enroll in Medicare if such individuals would otherwise qualify for Medicare at the age of 65. The Centers for Medicare & Medicaid Services (CMS) must determine enrollment periods and set premiums for the buy-in option established under the bill, in accordance with specified requirements. The CMS must also
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Acupuncture for Heroes and Seniors Act of 2019 [HB-1183]
To amend title 10, United States Code, to ensure access to qualified acupuncturist services for military members and military dependents, to amend title 38, United States Code, to ensure access to acupuncturist services through the Department of Veterans Affairs, to amend title XVIII of the Social Security Act to provide for coverage of qualified acupuncturist services under the Medicare program; to amend the Public Health Service Act to authorize the appointment of qualified acupuncturists as officers in the commissioned Regular Corps and the Ready
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Social Security and Medicare Lock-Box Act [HB-1215]
Establishes (1) in the Federal Old-Age and Survivors Insurance Trust Fund, a Social Security Surplus Protection Account; and (2) in the Federal Hospital Insurance Trust Fund, a Medicare Surplus Protection Account. The Managing Trustee of each trust fund (in both cases, the Secretary of the Treasury) (1) must transfer the annual surplus of the trust fund to its respective account; and (2) may not invest the balance in the account until a law takes effect that authorizes, for amounts in the trust fund, an investment vehicle other than U.S. obligations.
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Home Health Payment Innovation Act of 2019 [S.433]
Makes a series of changes relating to payment and coverage of home health services under Medicare and Medicare Advantage (MA). Specifically, the bill allows the home-confinement requirement (also known as the homebound requirement) for home health services to be waived under Medicare and MA. Currently, as a condition of eligibility for such services, a physician must certify that an individual has difficulty leaving home without assistance (e.g., a wheelchair, special transportation, or help from another person) due to an illness or injury. The
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Medicare Negotiation and Competitive Licensing Act of 2019 [S.377]
Requires the Centers for Medicare & Medicaid Services (CMS) to negotiate with pharmaceutical companies regarding prices for drugs covered under the Medicare prescription drug benefit. (Current law prohibits the CMS from doing so.) The CMS must take certain factors into account during negotiations, including the clinical- and cost-effectiveness of the drug, the financial burden on patients, and unmet patient needs. If the CMS is unable to negotiate the price of a drug, such drug is subject to competitive licensing in order to further its sale under
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Resident Physician Shortage Reduction Act of 2019 [S.348]
Increases the number of residency positions eligible for graduate medical education payments under Medicare for qualifying hospitals, with an aggregate increase of 3,000 positions per fiscal year for five years. Of these positions, at least 1,500 per fiscal year must be for residents in a shortage specialty residency program (i.e., a program in a specialty in which baseline physician requirements projections exceed the projected supply of total active physicians, as identified by the Health Resources and Services Administration in a specified report).
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Home Health Care Planning Improvement Act of 2019 [S.296]
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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Rural Physician Workforce Production Act of 2019 [S.289]
Allows hospitals and critical access hospitals to receive payment under Medicare for each resident that receives training in a rural training location, in accordance with specified criteria and limitations.
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Mental Health Access Improvement Act of 2019 [S.286]
Provides for coverage of marriage and family therapist services and mental health counselor services under Medicare. It also excludes such services from the skilled nursing facility prospective payment system, and authorizes marriage and family therapists and mental health counselors to develop discharge plans for post-hospital services.
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Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2019 [S.283]
Specifies that certain Medicare payment rules applicable to imaging services shall apply to dual-energy x-ray absorptiometry services used in bone mass scans beginning in 2019. The Centers for Medicare & Medicaid Services must establish national minimum payment amounts for such services.
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Promoting Access to Diabetic Shoes Act [S.237]
Allows a nurse practitioner or physician assistant to fulfill documentation requirements for coverage, under Medicare, of special shoes for diabetic individuals. Under current law, such requirements may be satisfied only by a physician.
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Non-Emergency Ambulance Transportation Sustainability and Accountability (NEATSA) Act of 2019 [S.228]
Decreases the percentage by which Medicare payments must be reduced in 2019 for nonemergency ambulance transports of end-stage renal disease patients. Beginning in 2020, the bill increases the percentage reduction for certain providers that mostly furnish such services, as designated by the Centers for Medicare & Medicaid Services (CMS). The CMS must publish data regarding such payments and providers on its website.
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Medicare Drug Price Negotiation Act [S.99]
Makes a series of changes relating to the prices of prescription drugs under the Medicare prescription drug benefit and Medicare Advantage (MA) prescription drug plans (PDPs). Under current law, the Centers for Medicare & Medicaid Services (CMS) may neither negotiate the prices of covered drugs nor establish a formulary. The bill repeals these restrictions and instead specifically requires the CMS to (1) negotiate the prices of covered drugs; and (2) either establish a formulary for covered drugs, or require changes to PDP formularies that take
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Empowering Medicare Seniors to Negotiate Drug Prices Act of 2019 [S.62]
Allows the Centers for Medicare & Medicaid Services to (1) negotiate drug prices under the Medicare prescription drug benefit, and (2) institute a price structure for the reimbursement of drugs covered under the benefit.