Legislative Activity

The "SMART Health Care Act" aims to amend Title XVIII of the Social Security Act to modify Medicare Advantage risk adjustment, promote site-neutral payments, increase Medicare access in rural areas, lower drug costs for Medicare patients, and improve the quality of care in skilled nursing facilities. This bill requires the Secretary to use two years of diagnostic data for risk adjustment methodology starting in 2026. Additionally, it modifies Medicare payment rules for services provided in hospital outpatient departments and revises criteria for rural providers concerning designated health services. The bill also seeks to ensure that covered entities provide covered outpatient drugs to patients at a price no higher than what the entity paid for the drug, and increases the percentage points for skilled nursing facilities.

The "Combatting Hospital Monopolies Act" aims to expand the Federal Trade Commission's (FTC) authority to include oversight of non-profit hospitals and cooperative hospital service organizations. This change allows the FTC to regulate these entities under the same antitrust laws as for-profit hospitals. The goal of the act is to prevent monopolistic practices within the healthcare industry.

The "Addressing Anti-Competitive Health Care Contract Clauses Act" aims to study and address the impact of specific contract clauses within the healthcare industry that may stifle competition and negatively affect consumer prices and access to care. It mandates a study by the Comptroller General, in coordination with the Federal Trade Commission and the Department of Justice, to assess the effects of anti-steering, anti-tiering, all-or-nothing, and gag clauses in contracts between health insurers and healthcare providers. The study will evaluate the enforcement capabilities of the Federal Trade Commission and the Department of Justice and recommend actions to enhance resources if necessary. The results of the study will be reported to specific committees in both the House of Representatives and the Senate.

The "Measuring State Healthcare Freedom Act" mandates an annual study by the Department of Health and Human Services on healthcare competition and consolidation within each state for the next 10 years. This study will analyze licensing requirements, mergers, state laws, insurance options, and the number of healthcare providers, and calculate the Herfindahl-Hirschman Index to measure market concentration. The findings will be reported to Congress and made available to the public.

The Holding Nonprofit Hospitals Accountable Act aims to ensure that nonprofit hospitals provide sufficient community benefits to justify their tax-exempt status. It sets minimum spending requirements on patient care improvements and financial assistance, limits facility and equipment expenditures, and mandates that financial assistance policies consider Medicare rates. The Act also requires regular reviews and reports on hospital financial assistance policies and IRS enforcement of community benefit standards. These changes will take effect for taxable years starting after December 31, 2025.

The "Preventing Hospital Overbilling of Medicare Act" aims to reduce Medicare overspending by ensuring that off-campus hospital locations are billed at the appropriate, lower rate. It achieves this by removing certain exceptions that allow hospitals to bill at higher rates for services provided at these off-campus locations and by requiring these locations to have unique identifiers for billing purposes. The Act also directs the Secretary of Health and Human Services to promote similar billing practices among private insurers. These changes are intended to take effect starting January 1, 2026.

The "Empowering Patient Choice of Medical Care Act" aims to broaden access to outpatient hospital services for Medicare beneficiaries. Starting January 1, 2026, the Secretary of Health and Human Services can designate services for outpatient care, regardless of whether they could be safely provided in an inpatient setting. This change intends to provide patients with more choices regarding where they receive medical care.

The "Restoring Rights of Medical Residents Act" repeals a section of the Pension Funding Equity Act of 2004, specifically Section 207. This change will go into effect on March 18th of the year following the bill's enactment.

The "Restoring Rights of Physicians to Own Hospitals Act" repeals certain requirements for hospitals to qualify for exceptions to the prohibition of physician ownership or investment. This change affects Section 1877 of the Social Security Act, specifically concerning rural providers and hospitals. The goal of the act is to restore the rights of physicians to own hospitals.

The Delphi Retirees Pension Restoration Act aims to restore the full pension benefits to eligible participants and beneficiaries under specific terminated pension plans, such as the Delphi Hourly-Rate Employees Pension Plan. It mandates the recalculation of benefits to match the full vested plan benefit, provides for lump-sum payments to cover past underpayments with interest, and funds these increased benefits through existing resources. The bill also includes provisions for the tax treatment of these payments, allowing recipients to spread the income over three years.