Medicare

Current understanding

Rules and legislation changing Medicare coverage, payment rates, or eligibility.

Evidence log

• 2026-11-03 — Medicare and Medicaid Programs; Organ Procurement Organizations Conditions for Coverage: Revisions to the Conditions for Coverage: CMS issued a final rule refining organ procurement organization designation, competition, and appeals procedures under Conditions for Coverage, changing administrative requirements for affected organizations while retaining established donor and transplant volume performance standards, with no direct beneficiary coverage or cost-sharing change identified. (novelty: 3)
• 2026-11-06 — Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; including the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Program; Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency (HPT) Data; Prior Authorization; Accrediting Organization (AO) Deeming for Emergency Medical Treatment and Labor Act (EMTALA); and Notices of Closure of Teaching Hospitals and Opportunities To Apply for Available Slots: CY 2027 Hospital OPPS and ASC Payment Systems final rule: CMS finalized outpatient hospital and ambulatory surgical center payment rates and quality reporting updates, expanded prior authorization for botulinum toxin injections, and permitted accrediting organizations to survey certain EMTALA requirements, advancing the previously logged proposal to binding payment and compliance standards for affected providers. (novelty: 4)
• 2026-11-09 — Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program: CY 2027 Physician Fee Schedule final rule: CMS finalized Part B payment and coverage policies, Quality Payment Program adjustments, and Shared Savings Program requirements, advancing the previously logged proposal to binding standards affecting clinician reimbursement and participating providers’ compliance obligations. (novelty: 4)
• 2026-11-09 — Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based Purchasing Model; Medicare Provider Enrollment, Durable Medical Equipment (DME), and DME, Prosthetics, Orthotics, and Supplies (DMEPOS) Policies: CY 2027 Home Health PPS final rule: CMS finalized home health agency payment rates and case-mix adjustments, updated home health quality reporting and expanded value-based purchasing requirements, and revised Medicare provider enrollment and DME/DMEPOS policies, moving the previously logged proposal to final status and changing provider reimbursement and compliance requirements. (novelty: 3)
• 2026-11-09 — Medicare Drug Price Negotiation Program and Medicare Prescription Drug Benefit Program: CMS finalized regulatory standards for the Medicare Drug Price Negotiation Program and related Part D policies, including fixed-combination drug treatment, establishing the framework for negotiated prices on affected prescriptions rather than an across-the-board reduction in beneficiary drug costs. (novelty: 4)
• 2026-10-22 — To amend titles II and XVIII of the Social Security Act to lower the Medicare eligibility age to 50, and for other purposes.: 2026 — Bill to lower Medicare eligibility age to 50 (House, introduced): would amend titles II and XVIII of the Social Security Act to drop Medicare’s eligibility age from 65 to 50, potentially extending public coverage to tens of millions of working-age adults; referred to committee with no binding effect pending enactment. (novelty: 4)
• 2026-10-29 — To amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans.: 2026 — Medicare for America bill (House, introduced): would amend the Social Security Act to establish a new ‘Medicare for America’ program providing comprehensive coverage to all Americans; referred to committee with no binding effect pending enactment. (novelty: 3)
• 2026-10-22 — Medicare Low Income Subsidy Equality Act of 2026: 2026 — Medicare Low Income Subsidy Equality Act of 2026 (House, introduced): would address equality in Medicare’s Part D Low-Income Subsidy for prescription-drug costs; referred to committee with no legal effect pending enactment. (novelty: 2)
• 2015-12-18 — Consolidated Appropriations Act, 2016: 2015-12-18 — Consolidated Appropriations Act, 2016 (enacted): FY2016 omnibus paired with the PATH Act tax package; healthcare riders focused on 9/11 responder coverage rather than substantive Medicare benefit or payment changes. (novelty: 4)
• 2026-10-20 — Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026: 2026 — CMS Proposed Rule implementing CAA 2026 §§6219, 6220, 6224: would change Medicare Part D cost-sharing for low-income enrollees, require more accurate provider directories, and impose new PBM accountability requirements. (novelty: 3)
• 2026-10-30 — Medicare Program; CY 2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury (AKI) Dialysis Payment, and ESRD Quality Incentive Program: 2026 — CY 2027 ESRD PPS, AKI Dialysis Payment, and ESRD QIP Final Rule: CMS finalizes routine annual updates to the ESRD bundled payment rate, AKI dialysis payment rate, and ESRD Quality Incentive Program measures that adjust clinic payments based on quality performance. (novelty: 2)
• 2026-07-14 — Cure Hepatitis C Act of 2026: 2026 — Cure Hepatitis C Act of 2026 (introduced): would waive Medicare beneficiary cost-sharing (deductibles and coinsurance) for hepatitis C drugs from 2028 through 2032, eliminating out-of-pocket costs for covered antivirals during that period. (novelty: 3)
• 2026-10-02 — Global Benchmark for Efficient Drug Pricing (GLOBE) Model: 2026 — GLOBE Model (final rule): mandatory CMMI test alters how Part B drug inflation rebates are calculated for traditional Medicare, with CMS targeting lower beneficiary cost-sharing and program spending on affected drugs. (novelty: 3)
• 2002-03-21 — Establishing the congressional budget for the United States Government for fiscal year 2003 and setting forth appropriate budgetary levels for each of fiscal years 2004 through 2007.: 2002 — FY2003 House Budget Resolution (House-passed): established a reserve fund contemplating Medicare modernization and a prescription-drug benefit but did not itself change Medicare coverage or payments and was not adopted by both chambers. (novelty: 2)
• 2025-07-24 — Equitable Community Access to Pharmacist Services Act: 2025 — Equitable Community Access to Pharmacist Services Act (Senate, introduced): would permanently add Medicare Part B payment for pharmacist testing and treatment of COVID-19, flu, RSV, strep throat, and other conditions during a declared public health emergency, subject to state scope-of-practice law. (novelty: 2)
• 2025-11-07 — Seniors Deserve SMARTER Care Act of 2025: 2025 — Seniors Deserve SMARTER Care Act of 2025 (introduced): referred to House Ways and Means and Energy and Commerce, signaling proposed Medicare-related provisions for senior care; substantive text not yet publicly detailed. (novelty: 2)
• 2025-04-28 — Expanding Remote Monitoring Access Act: 2026 — Expanding Remote Monitoring Access Act (House, introduced): would require Medicare for two years post-enactment to cover remote patient monitoring when a device collects data on only 2 days in a 30-day period (vs. the current 16-day minimum), and direct CMS to report on the coverage. (novelty: 3)
• 2025-04-24 — Medicare Protection Act of 2025: 2025 — Medicare Protection Act of 2025 (introduced): would exclude proceeds from the sale of a beneficiary’s primary residence from the modified adjusted gross income used to calculate Medicare Part B income-related monthly adjustment amounts (IRMAA), preventing home-sale gains from triggering higher premiums. (novelty: 2)
• 2026-05-21 — Rural Community Hospital Demonstration Program Reauthorization: 2026 — Rural Community Hospital Demonstration Program Reauthorization (introduced): would extend a Medicare cost-based payment demonstration for small rural hospitals ineligible for CAH status by five years, preserving an alternative payment pathway for a limited set of rural facilities. (novelty: 2) (novelty: 2)
• 2026-05-21 — DME Scammer Prevention Act of 2026: 2026 — DME Scammer Prevention Act of 2026 (committee-advanced): would require Medicare suppliers of high-risk DME on CMS’s master list to file claims electronically within 90 days of furnishing items, and direct GAO to report on Medicare contractor fraud detection for those claims. (novelty: 2)
• 2026-05-12 — SAFE through Medicare Act: 2026 — SAFE through Medicare Act (introduced): would add a Medicare benefit covering medically necessary home resiliency items (heat pumps, backup batteries for medical equipment, energy-efficient storage for medical supplies) for beneficiaries judged medically at risk in a climate or manmade disaster. (novelty: 2)
• 2026-04-16 — Ensuring Access to Lower-Cost Medicines for Seniors Act: 2026 — Ensuring Access to Lower-Cost Medicines for Seniors Act (introduced): would require Medicare Part D plans to include generic drugs and biosimilars on formularies with utilization-management requirements no more restrictive than for brand-name products and to maintain specific cost-sharing tiers for them. (novelty: 3)
• 2025-07-30 — Protecting Health Care and Lowering Costs Act: 2026 — Protecting Health Care and Lowering Costs Act (S2556, introduced): would repeal Medicare provisions enacted by the OBBBA, unwinding recent statutory changes to Medicare coverage or payment. (novelty: 3)
• 2025-03-11 — Medicare Dental, Hearing, and Vision Expansion Act of 2025: 2025 — Medicare Dental, Hearing, and Vision Expansion Act of 2025 (introduced): would add dental/oral health, hearing aid, and vision (including routine exams and eyeglasses) benefits to Medicare via CMS fee schedules, with a three-year Part B premium phase-in beginning 2028. (novelty: 3)
• 2026-01-08 — Access to Genetic Counselor Services Act of 2026: 2026 — Access to Genetic Counselor Services Act of 2026 (S3607, introduced): referred to Senate Finance Committee, signaling a Medicare coverage pathway to recognize and reimburse genetic counselor services currently not covered as a distinct Medicare provider category. (novelty: 3)
• 2025-12-11 — Metastatic Breast Cancer Access to Care Act: 2025 — Metastatic Breast Cancer Access to Care Act (S3442, introduced): would waive the 24-month Medicare waiting period for SSDI recipients with metastatic breast cancer, accelerating Medicare eligibility for this diagnosis. (novelty: 3) (novelty: 3)
• 2025-03-27 — Portable Ultrasound Reimbursement Equity Act of 2025: 2025 — Portable Ultrasound Reimbursement Equity Act of 2025 (introduced): would require Medicare to cover ultrasound tests performed in a beneficiary’s home and make separate payments for portable ultrasound services on the same basis as existing portable X-ray services. (novelty: 2)
• 2025-07-09 — Prevent Interruptions in Physical Therapy Act of 2025: 2025 — Prevent Interruptions in Physical Therapy Act of 2025 (introduced): would let physical therapists bill Medicare for services furnished by a substitute PT under a qualifying temporary arrangement in any geographic area, removing the current restriction to rural, medically underserved, or health professional shortage areas. (novelty: 2)
• 2025-04-08 — Medicare Enrollment Protection Act of 2025: 2025 — Medicare Enrollment Protection Act of 2025 (introduced): would create a once-per-lifetime special enrollment period allowing individuals on COBRA at Medicare eligibility to enroll in Medicare during any month of COBRA coverage and for three months after it ends, closing a late-enrollment penalty gap for COBRA-to-Medicare transitions. (novelty: 2)
• 2026-08-04 — Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2027 Rates; Requirements for Quality Programs; Other Policy Changes; and Adoption of Updated Versions of Certain Health Information Technology Standards: 2026 — FY 2027 IPPS/LTCH PPS Final Rule: CMS finalized routine annual updates to acute care hospital inpatient and long-term care hospital prospective payment rates, graduate medical education policies, hospital quality program requirements, and adopted updated versions of certain health IT standards. (novelty: 2)
• 2026-07-30 — Medicare Access to Radiology Care Act of 2026: 2026 — Medicare Access to Radiology Care Act of 2026 (HR9984, introduced): referred to House Energy and Commerce and Ways and Means; would address Medicare beneficiary access to radiology care, with substantive provisions not yet publicly detailed beyond committee referral. (novelty: 2)
• 2026-07-30 — Veterans Medicare Premium Transparency Act: 2026 — Veterans Medicare Premium Transparency Act (HR10012, introduced): referred to House Ways and Means, Energy and Commerce, and Veterans’ Affairs; would address transparency of Medicare premiums for veterans, though substantive text is not yet publicly detailed. (novelty: 2)
• 2025-02-13 — Protecting America’s Seniors’ Access to Care Act: 2026 — Protecting America’s Seniors’ Access to Care Act (introduced): would prohibit CMS from enforcing the May 2024 minimum nurse staffing standards for Medicare-participating long-term care facilities, blocking a Conditions of Participation-linked staffing floor. (novelty: 2)
• 2026-07-22 — FAIR DME Appeals Act: 2025 — FAIR DME Appeals Act (S5062, 119th Congress, introduced): referred to Senate Finance Committee; would address the Medicare appeals process for durable medical equipment claims, with substantive provisions not yet publicly detailed. (novelty: 2)
• 2026-06-11 — Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2027: 2026-06-11 — Labor-HHS-Education Appropriations FY2027 (HR9260, placed on Union Calendar): would set FY2027 discretionary funding for CMS program management supporting Medicare operations, though Medicare benefits themselves are mandatory spending outside the bill. (novelty: 2)
• 2026-07-31 — Medicare Program; FY 2027 Inpatient Psychiatric Facilities Prospective Payment System-Rate Update: 2026 — FY 2027 Inpatient Psychiatric Facilities PPS Final Rule: CMS finalizes routine annual updates to IPF payment rates, outlier policy, and wage index; implements a standardized IPF patient assessment instrument; and removes two measures from the IPF Quality Reporting Program. (novelty: 2)
• 2026-08-03 — Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements: 2026 — FY 2027 Hospice Wage Index Final Rule: CMS finalizes routine annual updates to hospice payment rates, wage index, and aggregate cap, requires hospices to provide the election statement addendum to all Medicare beneficiaries at election, and makes conforming updates to face-to-face encounter, discharge, and Hospice Quality Reporting Program rules. (novelty: 2)
• 2026-07-29 — A bill to amend titles XVIII and XIX of the Social Security Act to make improvements relating to the designation of rural emergency hospitals.: 2025 — S5164 (introduced): would amend Medicare Title XVIII provisions governing designation of rural emergency hospitals, an incremental adjustment to the REH payment/designation framework created under prior law. (novelty: 2)
• 2026-07-31 — Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027: 2026 — FY 2027 Skilled Nursing Facility PPS Final Rule: CMS finalizes routine annual updates to SNF prospective payment rates and policies, along with changes to the SNF Quality Reporting Program and SNF Value-Based Purchasing Program. (novelty: 2)
• 2026-07-22 — Medicare Dental Benefit Act of 2026: 2026 — Medicare Dental Benefit Act of 2026 (S5089, introduced): would establish a dental benefit under the Medicare program, adding a coverage category currently excluded by Medicare statute. (novelty: 3)
• 2025-01-24 — Choices for Increased Mobility Act of 2025: 2025 — Choices for Increased Mobility Act of 2025 (introduced): would direct CMS to establish separate Medicare HCPCS billing codes for ultralightweight manual wheelchair bases made with vs. without titanium or carbon fiber, and permit DME suppliers to balance-bill beneficiaries for charges above the Medicare payment amount. (novelty: 2)
• 2025-12-10 — Joe Fiandra Access to Home Infusion Act of 2025: 2025 — Joe Fiandra Access to Home Infusion Act of 2025 (introduced): would extend Medicare coverage to external infusion pumps and associated home infusion drugs that must be administered or supervised by a healthcare professional in the home at least 12 times per year, filling a DME/home-infusion coverage gap for professionally administered pump therapies. (novelty: 3)
• 2026-07-15 — Improving Seniors’ Timely Access to Care Act of 2025: 2025 — Improving Seniors’ Timely Access to Care Act of 2025 (introduced): would require Medicare Advantage plans to adopt electronic prior authorization, meet CMS timeliness and quality standards, publicly report approval rates and response times, and support analysis of AI’s impact on beneficiary access. (novelty: 2)
• 2026-05-21 — Improving Access to Medicare Coverage Act of 2026: 2026 — Improving Access to Medicare Coverage Act of 2026 (introduced): would count hospital outpatient observation time as inpatient days toward Medicare’s three-day inpatient stay requirement for skilled nursing facility coverage, reintroducing the 2025 proposal to close the observation-status SNF eligibility gap. (novelty: 3)
• 2025-07-22 — Medicare Mental Health Inpatient Equity Act of 2025: 2025 — Medicare Mental Health Inpatient Equity Act of 2025 (introduced): would eliminate the 190-day lifetime cap on inpatient psychiatric hospital services under Medicare, expanding an established Part A benefit. (novelty: 3)
• 2026-05-19 — Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services of the Department of Health and Human Services relating to “Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model”.: 2026 — CRA joint resolution to disapprove CMS’s WISeR Model prior-authorization rule (AI-assisted third-party contractors performing PA on select fee-for-service Medicare services in six states, paid on shared savings) failed 46–50 in the Senate, leaving the model in effect. (novelty: 3)
• 2025-01-16 — Medicare Hearing Aid Coverage Act of 2025: 2025 — Medicare Hearing Aid Coverage Act of 2025 (introduced): would add Medicare coverage for hearing aids and related examinations and require GAO to study hearing-aid assistance programs, ending Medicare’s statutory exclusion of hearing aids. (novelty: 2)
• 2025-04-10 — SOAR Act of 2025: 2025 — SOAR Act of 2025 (introduced): would carve supplemental oxygen and related equipment/services out of Medicare’s competitive acquisition program, set separate inflation-indexed payments, add a payment adjustment for respiratory therapist services, require a CMS electronic prescribing template, and codify beneficiary rights including supplier choice. (novelty: 3)
• 2026-07-21 — Lainie Jones Comprehensive Cancer Survivorship Act of 2026: 2026 — Lainie Jones Comprehensive Cancer Survivorship Act of 2026 (S5052, introduced): Senate Finance Committee referral signals Medicare-related survivorship coverage provisions, though substantive bill text is not yet public. (novelty: 2)
• 2026-07-15 — Improving Access to Transfusion Care for Hospice Patients Act of 2026: 2026 — Improving Access to Transfusion Care for Hospice Patients Act of 2026 (introduced): would direct CMMI to test a Medicare model paying separately for blood transfusions furnished to hospice patients outside the hospice per-diem and evaluate impacts on hospital use and hospice length of stay. (novelty: 3)
• 2026-03-19 — Stand Strong Falls Prevention Act: 2025 — Stand Strong Falls Prevention Act (S2833, introduced): the bill’s advisory committee would recommend a Medicare pilot covering basic home modifications for fall prevention, potentially opening a new Medicare benefit category if the pilot advances. (novelty: 3)
• 2025-03-10 — Further Additional Continuing Appropriations and Other Extensions Act, 2025: 2025 — Further Additional Continuing Appropriations and Other Extensions Act, 2025 (enacted): extends expiring Medicare authorities alongside the CR funding federal agencies through April 11, 2025, preserving existing programs without substantive coverage or payment changes. (novelty: 2)
• 2025-04-02 — EASE Act: 2025 — EASE Act (S1248, introduced): would establish a CMMI demonstration delivering telehealth specialty care to rural Medicare beneficiaries through nonprofit networks of FQHCs, RHCs, CAHs, and rural emergency hospitals. (novelty: 3)
• 2025-04-01 — ABC Act: 2025 — ABC Act (HR2491, introduced): reframed scope confirms the review mandate extends beyond CMS to include SSA, covering Medicare eligibility/application/forms/communications alongside Social Security processes for family caregivers. (novelty: 3)
• 2025-04-01 — CARE Act of 2025: 2025 — CARE Act of 2025 (introduced): would require CMMI to test a five-year Medicare payment model for ground ambulance emergency responses without patient transport, with rates generally aligned to transport payment, and direct GAO to report on beneficiary EMS access and model impacts. (novelty: 3)
• 2025-04-01 — EASE Act of 2025: 2025 — EASE Act of 2025 (introduced): would direct CMMI to test a nonprofit provider-network telehealth specialty care model for rural Medicare beneficiaries delivered through FQHCs, RHCs, CAHs, and rural emergency hospitals. (novelty: 3)
• 2025-03-31 — ABC Act: 2025 — ABC Act (HR2491, introduced): would direct CMS to review and streamline Medicare eligibility, application, forms, and communications processes to reduce duplicative paperwork burdens on family caregivers. (novelty: 2) (novelty: 2)
• 2025-03-27 — EASE Act of 2025: 2025 — EASE Act of 2025 (introduced): would require hospitals to provide Medicare hospice-eligible patients with information about local hospice providers during discharge planning, adding a disclosure requirement without changing hospice coverage or payment. (novelty: 2)
• 2025-03-25 — FAIR Act: 2025 — FAIR Act (introduced): would require hospitals receiving Medicare GME payments to report osteopathic and allopathic residency applicant/acceptance counts to CMS and attest they consider both, with a 2% GME payment reduction for noncompliance and public posting of the data. (novelty: 2)
• 2025-03-14 — Block Organ Transplant Purchases from China Act of 2025: 2025 — Block Organ Transplant Purchases from China Act of 2025 (HR2114, introduced): would prohibit Medicare from covering organ transplants performed in China or using organs not procured through the U.S. OPTN. (novelty: 3)
• 2026-07-23 — A bill to amend title XVIII of the Social Security Act to expand access to psychological and behavioral health services.: 2026 — S5120 (introduced): would amend title XVIII of the Social Security Act to expand Medicare access to psychological and behavioral health services. (novelty: 2)
• 2025-05-08 — Medicare and Social Security Fair Share Act: 2025 — Medicare and Social Security Fair Share Act (S1690, 119th Congress, introduced): read twice and referred to Senate Finance Committee; substantive provisions addressing Medicare and Social Security financing not yet publicly detailed. (novelty: 2)
• 2025-05-14 — Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2025: 2025 — Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2025 (introduced): would adjust Medicare hospital payments to offset compliance costs of new federal minimum nurse-to-patient ratios, tying staffing standards to Medicare reimbursement. (novelty: 3)
• 2025-01-16 — Chiropractic Medicare Coverage Modernization Act of 2025: 2025 — Chiropractic Medicare Coverage Modernization Act of 2025 (introduced): would expand Medicare coverage of chiropractic services beyond manual manipulation of the spine for subluxation to encompass all services furnished by chiropractors within their state scope of practice. (novelty: 2)
• 2025-03-25 — John W. Walsh Alpha-1 Home Infusion Act of 2025: 2025 — John W. Walsh Alpha-1 Home Infusion Act of 2025 (introduced): would add Medicare coverage for at-home AAT augmentation therapy furnished by qualified home infusion suppliers for beneficiaries with emphysema due to severe hereditary alpha-1 antitrypsin deficiency. (novelty: 3)
• 2026-06-30 — Residential Recovery for Seniors Act: 2026-06-30 — Residential Recovery for Seniors Act (HR9538, introduced): referred to House Ways and Means, signaling proposed Medicare-related provisions for senior residential recovery services; no substantive text yet public. (novelty: 2) (novelty: 2)
• 2026-05-21 — Improving Home Dialysis Act of 2026: 2026-05-21 — Improving Home Dialysis Act of 2026 (HR8875) ordered reported as a substitute 28-13, advancing proposed changes to Medicare coverage/payment rules supporting home dialysis. (novelty: 3)
• 2025-06-26 — CONNECT for Health Act of 2025: 2025 — CONNECT for Health Act of 2025 (HR4206, introduced): would permanently remove Medicare telehealth geographic and originating-site restrictions and expand eligible practitioners and services, making pandemic-era flexibilities permanent. (novelty: 3)
• 2026-04-16 — KIDNEY Remote Monitoring Act: 2026 — KIDNEY Remote Monitoring Act (HR8319, introduced): dual referral to Energy and Commerce and Ways and Means signals proposed changes to Medicare coverage or payment for remote patient monitoring in kidney care. (novelty: 3)
• 2026-03-05 — PrEP Access and Coverage Act of 2026: 2026 — PrEP Access and Coverage Act of 2026 (HR7853, introduced): referred to House Ways and Means among other committees, implicating Medicare coverage and cost-sharing rules for HIV pre-exposure prophylaxis. (novelty: 2) (novelty: 2)
• 2026-06-18 — FAST Repairs for Wheelchairs Act: cross-connection with fast-repairs-for-wheelchairs-act: Wheelchair repair timeliness is governed by Medicare DME supplier rules; the bill would modify those requirements. (novelty: 2)
• 2026-05-21 — Provider Reimbursement Stability Act of 2026: 2026-05-21 — Provider Reimbursement Stability Act of 2026 (HR8163) ordered to be reported as a substitute by unanimous 44-0 committee vote, advancing a standalone bill on Medicare provider reimbursement stability. (novelty: 3)
• 2026-07-15 — Medicare Premiums Reduction Act of 2026: 2026 — Medicare Premiums Reduction Act of 2026 (HR9709, introduced): referred to House Energy and Commerce and Ways and Means; would address Medicare premium costs, with no substantive text yet public beyond committee referral. (novelty: 2)
• 2026-07-18 — Choices for Increased Mobility Act of 2026: 2026 — Choices for Increased Mobility Act of 2026 (introduced): would direct CMS to create separate Medicare HCPCS billing codes for ultralightweight manual wheelchair bases made with vs. without titanium or carbon fiber, and permit DME suppliers to balance-bill beneficiaries for charges above the Medicare payment amount. (novelty: 2)
• 2026-07-16 — A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services of the Department of Health and Human Services relating to “Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model”.: 2026 — Senate CRA joint resolution to disapprove CMS’s WISeR Model (AI-assisted prior authorization by third-party contractors for selected Medicare services in six states) rejected 46–50; the model remains in effect for fee-for-service Medicare in the pilot states. (novelty: 3)
• 2026-07-15 — Medicare Access to Rural Anesthesiology Act: 2026 — Medicare Access to Rural Anesthesiology Act (HR9642, advanced unanimously out of committee): would improve Medicare beneficiary access to anesthesiology services in rural areas, targeting a specific rural specialty access gap in Medicare payment/coverage policy. (novelty: 2)
• 2026-07-15 — Medicare Advantage MLR Transparency Act: 2026 — Medicare Advantage MLR Transparency Act (HR9644, introduced): would strengthen transparency requirements around Medical Loss Ratios for Medicare Advantage plans. (novelty: 2)
• 2026-04-30 — Ensuring Seniors’ Access to Quality Care Act: 2025 — Ensuring Seniors’ Access to Quality Care Act (introduced): would ease Medicare/Medicaid bans on nurse-aide training programs at skilled nursing facilities that faced quality-of-care sanctions once corrective action is complete, and let SNFs query the National Practitioner Data Bank on affiliated practitioners’ disciplinary records. (novelty: 2)
• 2026-02-26 — Medical Nutrition Therapy Act of 2026: 2026 — Medical Nutrition Therapy Act of 2026 (introduced): would expand Medicare-covered MNT to obesity, eating disorders, cancer, and HIV/AIDS, and broaden referring providers to include PAs, NPs, clinical nurse specialists, and clinical psychologists (for eating disorders). (novelty: 3)
• 2026-06-25 — To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.: 2025 — HR5243 (introduced): would amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits (e.g., dental, vision, transportation, OTC allowances) offered under Medicare Advantage plans. (novelty: 2) (novelty: 2)
• 2025-06-10 — Protecting Health Care for All Patients Act of 2025: 2025 — Protecting Health Care for All Patients Act of 2025 (introduced): would prohibit Medicare (including CMS and any contractor) from using QALYs or metrics that discount life value by disability, age, or terminal illness in coverage, reimbursement, or incentive decisions. (novelty: 3)
• 2026-07-14 — Securing Healthcare and Income Entitlements for Lawfully Domiciled Citizens (SHIELD Citizens) Act: 2026 — SHIELD Citizens Act (HR9667, introduced): would condition federal healthcare and income entitlements on lawful domicile/citizenship status, implicating Medicare eligibility via Ways and Means and Energy and Commerce referral; no substantive text yet public. (novelty: 2)
• 2026-07-15 — To amend title XVIII of the Social Security Act to modify certain physician payments under the Medicare program.: 2026 — HR9693 (introduced): would amend title XVIII of the Social Security Act to modify certain Medicare physician payments; bill title and committee referral only, no substantive text yet public. (novelty: 2)
• 2026-07-14 — Alignment Healthcare Inc. v. HHS: 2026-07-14 — Alignment Healthcare Inc. v. HHS: D.C. Circuit issued an appellate opinion resolving a dispute between a Medicare Advantage organization and HHS, providing incremental legal clarification relevant to MA plan administration. (novelty: 2)
• 2026-07-16 — Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program: 2026 — CY 2027 Physician Fee Schedule Proposed Rule: CMS proposes routine annual updates to Part B payment policies, Shared Savings Program and Quality Payment Program requirements, and payment rules for RHCs, FQHCs, ambulance services, clinical labs, and the Promoting Interoperability program. (novelty: 2) (novelty: 2)
• 2025-12-18 — Debt Solution and Accountability Act: 2025 — Debt Solution and Accountability Act (introduced): would require Treasury reports to Congress at debt-limit events to include long-run fiscal-sustainability projections for Medicare, elevating program solvency data in debt-ceiling deliberations without altering Medicare benefits or payments. (novelty: 2)
• 2025-12-02 — Hospital Inpatient Services Modernization Act: 2025 — Hospital Inpatient Services Modernization Act (HR4313, introduced): would extend Medicare’s Acute Hospital Care at Home Program through FY2030 and require CMS to study quality, costs, services, and patient demographics compared to traditional inpatient settings. (novelty: 2)
• 2026-06-29 — No Medicare Clawbacks Act of 2026: 2026 — No Medicare Clawbacks Act of 2026 (HR9532, introduced): referred to House Ways and Means and Energy and Commerce; would address Medicare clawback practices, though substantive text is not yet publicly detailed. (novelty: 2)
• 2026-06-30 — Save MEDICARE Act of 2026: 2026 — Save MEDICARE Act of 2026 (HR9544, introduced): referred to House Ways and Means, Energy and Commerce, and Veterans’ Affairs; substantive Medicare reform provisions not yet public. (novelty: 2)
• 2026-04-27 — Medicare Advantage Improvement Act of 2026: 2026-04-27 — Medicare Advantage Improvement Act of 2026 (HR8375, introduced): sponsor introductory remarks delivered in the 119th Congress; no substantive policy details yet public. (novelty: 2)
• 2026-03-12 — Diabetes Foot Health Access and Modernization Act of 2026: 2026-03-12 — Diabetes Foot Health Access and Modernization Act of 2026 (HR7905, introduced): referred to House Energy and Commerce and Ways and Means; targets expanded Medicare access to diabetes-related foot care services. (novelty: 2)
• 2025-03-10 — MATCH IT Act of 2025: 2025 — MATCH IT Act of 2025 (introduced): would create voluntary Medicare Promoting Interoperability program payment bonuses for providers meeting new HHS-defined patient-matching accuracy standards (targeting 99.9% match rates). (novelty: 3)
• 2025-04-01 — Workplace Violence Prevention for Health Care and Social Service Workers Act: 2025 — Workplace Violence Prevention for Health Care and Social Service Workers Act (introduced): would condition Medicare participation for hospitals and skilled nursing facilities on compliance with a new OSHA workplace violence prevention standard. (novelty: 3)
• 2025-09-18 — Protecting Free Vaccines Act: 2025-09-18 — Protecting Free Vaccines Act (HR5448, introduced): would require Medicare to cover ACIP-recommended vaccines (frozen at Oct 25, 2024 list) with no cost-sharing through Jan 1, 2030. (novelty: 2) (novelty: 2)
• 2025-03-14 — ROCR Value Based Program Act: 2026 — ROCR Value Based Program Act (introduced): would create a mandatory Medicare episode-based payment program for radiation oncology with fixed 30- or 90-day case rates by cancer type, plus geographic, transportation, and accreditation adjustments. (novelty: 3)
• 2026-02-03 — Prior Authorization Relief Act: 2025 — Prior Authorization Relief Act (S3762, introduced): referred to Senate Finance Committee; would reduce prior authorization burdens across healthcare coverage, with Medicare implicated via Finance Committee jurisdiction. (novelty: 2) (novelty: 2)
• 2025-03-06 — Securing Access to Care for Seniors in Critical Condition Act of 2025: 2025 — Securing Access to Care for Seniors in Critical Condition Act of 2025 (HR1924, introduced): would exempt high-acuity long-term care hospital (LTCH) discharges from Medicare’s site-neutral payment rate beginning October 1, 2026, restoring higher LTCH payment rates for qualifying discharges. (novelty: 2)
• 2026-03-27 — Ensuring Access to Lower-Cost Medicines for Seniors Act of 2026.: 2026-03 — Ensuring Access to Lower-Cost Medicines for Seniors Act of 2026 (HR8143, introduced): referred to House Energy and Commerce and Ways and Means; targets lower-cost medicine access for Medicare-eligible seniors. (novelty: 2)
• 2025-03-18 — Preserving Patient Access to Home Infusion Act: 2025 — Preserving Patient Access to Home Infusion Act (HR2172, introduced): would expand Medicare-covered home infusion therapy to include drugs administered without a pump and allow nurses and physician assistants to establish and review plans of care without a practitioner physically present. (novelty: 2)
• 2025-09-30 — Health Care Workforce Expansion Act of 2025: 2025 — Health Care Workforce Expansion Act of 2025 (introduced): would expand Medicare Graduate Medical Education (GME) residency slots with prioritization for psychiatry and primary care specialties. (novelty: 2)
• 2025-01-31 — Medicare Patient Access and Practice Stabilization Act of 2025: 2025 — Medicare Patient Access and Practice Stabilization Act of 2025 (HR879, introduced): would temporarily increase Medicare physician fee schedule payment adjustments for services furnished between April 1, 2025, and January 1, 2026. (novelty: 2)
• 2026-03-04 — Save Medicare Act: 2025 — Save Medicare Act (introduced): would rename the Medicare Advantage program to the ‘Alternative Private Health Plan’ program and impose civil penalties on entities marketing these plans using the Medicare name. (novelty: 2)
• 2026-03-12 — Removing Medicare Mental Health Inpatient Limitations Act of 2026: 2026 — Removing Medicare Mental Health Inpatient Limitations Act of 2026 (S4076, introduced): would eliminate the 190-day lifetime cap on inpatient psychiatric hospital services under Medicare. (novelty: 2)
• 2026-06-24 — Medicare Cost Cap Act of 2026: 2026 — Medicare Cost Cap Act of 2026 (S4886, introduced): referred to Senate Finance Committee; proposes to cap Medicare costs (no substantive detail publicly available at introduction). (novelty: 2)
• 2026-07-07 — Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; Including the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Program; Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency (HPT) Data; Prior Authorization; Accrediting Organization (AO) Deeming for Emergency Medical Treatment and Labor Act (EMTALA); and Notices of Closure of Teaching Hospitals and Opportunities To Apply for Available Slots: 2026 — CY 2027 Hospital OPPS and ASC Payment Systems Proposed Rule: CMS proposes routine annual updates to outpatient and ASC payment rates, expands prior authorization to Botulinum Toxin Injection services, and includes provisions on AO deeming for EMTALA and teaching hospital slot closures. (novelty: 2)
• 2026-06-18 — Request for Information (RFI): Pharmacy Benefit Manager Compensation and Data Collection: 2026 — CMS RFI on PBM Compensation and Data Collection: seeks stakeholder input to implement statutory PBM compensation limits and reporting obligations under Medicare Part D beginning in 2028. (novelty: 2)
• 2026-06-25 — Transparency in Medicare Advantage Steering Act: 2026-06 — Transparency in Medicare Advantage Steering Act (HR9395): forwarded by subcommittee to full committee by voice vote; would require transparency in how Medicare Advantage plans steer beneficiaries. (novelty: 2)
• 2025-02-27 — Acupuncture for Our Seniors Act of 2025: 2025 — Acupuncture for Our Seniors Act of 2025 (HR1667, introduced): would add Medicare coverage for acupuncturist services, including those furnished by physicians authorized under state law. (novelty: 2)
• 2025-04-03 — Telehealth Access for Tribal Communities Act of 2025: 2025 — Telehealth Access for Tribal Communities Act of 2025 (HR2639, introduced): would permanently extend Medicare coverage for audio-only, at-home telehealth services furnished through the Indian Health Service to tribal communities. (novelty: 3) (novelty: 3)
• 2025-04-02 — Protecting Options for Seniors Act of 2025: 2025 — Protecting Options for Seniors Act of 2025 (HR2610, introduced): would increase Medicare Advantage plan payments in areas where the average hospital wage index rose more than 20% year-over-year, with payment increases proportional to wage index growth. (novelty: 2)
• 2025-02-06 — Alternatives to PAIN Act: 2026 — Alternatives to PAIN Act (introduced): would require Medicare Part D plans to cover non-opioid pain management drugs with no deductible, lowest cost-sharing tier placement, and no prior authorization or step therapy. (novelty: 3) (novelty: 3)
• 2025-03-31 — COMPLETE Care Act: 2026 — COMPLETE Care Act (introduced): would temporarily raise Medicare payments for integrated behavioral health services by up to 175% from 2027–2029 and fund technical assistance for primary care practices adopting behavioral health integration models. (novelty: 2)
• 2026-06-01 — Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model: 2026 — Alternative Payment Model Updates and IOTA Model Final Rule: CMS updates the Increasing Organ Transplant Access (IOTA) Model for Performance Year 2 and makes a technical correction to the regulatory text. (novelty: 2)
• 2026-06-02 — Notice of Vacatur Regarding Certain Provisions of the 2024 Nondiscrimination in Health Programs and Activities Final Rule: 2026 — Notice of Vacatur (Section 1557 2024 Final Rule): a federal district court vacated the gender-identity discrimination provisions of HHS’s 2024 ACA Section 1557 nondiscrimination rule, affecting compliance obligations of Medicare-participating providers and insurers while leaving the balance of the rule in effect. (novelty: 3)
• 2026-06-16 — Medicare Drug Price Negotiation Program and Medicare Prescription Drug Benefit Program: 2026 — Medicare Drug Price Negotiation Program Proposed Rule: CMS proposes to codify the negotiation program and Part D benefit implementing policies under IRA 2022, including a revised fixed combination drug policy. (novelty: 3)
• 2026-06-16 — Medicare Program; Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflicts of Interest, and Related Provisions: 2026 — Strengthening Oversight of Accrediting Organizations Final Rule: CMS finalizes measures addressing AO conflicts of interest, updating validation and performance standards, revising psychiatric hospital survey processes, and limiting reentry of terminated providers into Medicare. (novelty: 2) (novelty: 2)
• 2026-06-24 — Medicare and State Health Care Programs: Fraud and Abuse; Request for Information Regarding the Federal Anti-Kickback Statute and Beneficiary Inducements CMP: 2026 — HHS Request for Information on Anti-Kickback Statute and Beneficiary Inducements CMP safe harbors: solicits public comment on whether safe harbor regulations should be modified to accommodate remuneration to clinical trial participants, which would affect what payments Medicare/Medicaid-participating researchers and sponsors can offer trial subjects. (novelty: 2) (novelty: 2)
• 2026-06-26 — Medicare Program; CY 2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury Dialysis (AKI) Payment, and ESRD Quality Incentive Program: 2026 — CY 2027 ESRD PPS, AKI Dialysis Payment, and ESRD QIP Proposed Rule: CMS proposes routine annual updates to the ESRD bundled payment rate, AKI dialysis payment, and ESRD Quality Incentive Program requirements for CY 2027. (novelty: 2)
• 2025-06-12 — Improving Access to Medicare Coverage Act of 2025: 2025 — Improving Access to Medicare Coverage Act of 2025 (HR3954, introduced): would count hospital outpatient observation time toward Medicare’s three-day inpatient stay requirement, allowing beneficiaries to qualify for skilled nursing facility coverage after observation stays. (novelty: 3)
• 2025-12-16 — Essential Caregivers Act of 2025: 2025 — Essential Caregivers Act of 2025 (introduced): would bar Medicare-participating nursing and rehabilitation facilities from restricting essential caregiver access to residents, even during emergencies, with narrow exceptions up to 14 days with state approval. (novelty: 2)
• 2025-02-04 — Stop the Wait Act of 2025: 2025 — Stop the Wait Act of 2025 (introduced): would eliminate the 24-month Medicare waiting period for SSDI recipients who cannot afford minimum essential coverage, accelerating Medicare eligibility for disabled beneficiaries. (novelty: 2)
• 2026-06-25 — Medicare Advantage Cost Transparency Act: 2026-06 — Medicare Advantage Cost Transparency Act (HR9392): forwarded by subcommittee to full committee by voice vote, would require greater cost transparency in Medicare Advantage plans. (novelty: 2)
• 2026-07-06 — Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based Purchasing Model; Medicare Provider Enrollment, Durable Medical Equipment (DME), and DME, Prosthetics, Orthotics, and Supplies (DMEPOS) Policies: 2026 — CY 2027 Home Health PPS Proposed Rule: CMS proposes routine updates to home health payment rates, case-mix weights, LUPA thresholds, HH Quality Reporting Program and expanded HH Value-Based Purchasing Model requirements, along with Medicare provider enrollment and DME/DMEPOS policy changes. (novelty: 2) (novelty: 2)
• 2026-06-04 — Critical Access Hospital RIP Act of 2026: 2026 — Critical Access Hospital RIP Act of 2026 (HR9163, introduced): referred to House Ways and Means, signaling proposed changes to Medicare reimbursement or regulatory provisions for Critical Access Hospitals. (novelty: 2) (novelty: 2)
• 2026-06-08 — Prior Authorization Reform for Autoimmune and Blood Disorders Act: 2026 — Prior Authorization Reform for Autoimmune and Blood Disorders Act (HR9192, introduced): would reform prior authorization requirements for autoimmune and blood disorders, with jurisdiction including Ways and Means (Medicare) alongside Energy and Commerce and Education and Workforce. (novelty: 2)
• 2026-06-02 — Patient Choice and Access Act of 2026: 2026 — Patient Choice and Access Act of 2026 (HR9107, introduced): referred to House Energy and Commerce Committee; bill title signals focus on patient choice and access but no substantive policy detail is yet public. (novelty: 2)
• 2025-02-13 — I CAN Act: 2026 — I CAN Act (introduced): would allow nurse practitioners, physician assistants, and clinical nurse specialists to perform additional documentation, supervision, and certification functions under Medicare currently restricted to physicians. (novelty: 2)
• 2025-10-03 — Medical Foods and Formulas Access Act of 2025: 2025 — Medical Foods and Formulas Access Act of 2025 (introduced): would require Medicare to cover medically necessary foods, formulas, and associated equipment prescribed for digestive or metabolic disorders. (novelty: 3) (novelty: 3)
• 2025-06-27 — Treat and Reduce Obesity Act of 2025: 2025 — Treat and Reduce Obesity Act of 2025 (introduced): would expand Medicare intensive behavioral therapy for obesity to additional provider types and add Part D coverage for FDA-approved weight-loss drugs. (novelty: 3)
• 2026-03-09 — MVP Act: 2026 — MVP Act (introduced): would exempt value-based purchasing arrangement sales from Medicare average sales price (ASP) calculations. (novelty: 3)
• 2026-04-14 — Chronic Care Management Improvement Act of 2026: 2026 — Chronic Care Management Improvement Act of 2026 (introduced): would eliminate patient cost-sharing (coinsurance and deductible) for chronic care management services under Medicare. (novelty: 2)
• 2025-02-24 — PREVENT DIABETES Act: 2025 — PREVENT DIABETES Act (introduced): would extend Medicare’s authorization for virtual delivery of Diabetes Prevention Program services by three years, through December 31, 2030. (novelty: 2)
• 2025-11-20 — Medical Nutrition Therapy Act of 2025: 2025 — Medical Nutrition Therapy Act of 2025 (introduced): would expand Medicare MNT coverage beyond diabetes and kidney disease to include obesity, eating disorders, cancer, and HIV/AIDS, and allow physician assistants, nurse practitioners, and clinical nurse specialists to refer patients. (novelty: 3) (novelty: 3)
• 2025-02-27 — Rebuild America’s Health Care Schools Act of 2025: 2025 — Rebuild America’s Health Care Schools Act of 2025 (citation removed) (introduced): would expand Medicare reimbursement for hospital nursing and allied health training costs to include training conducted at related entities under common ownership or control, not just on hospital premises. (novelty: 2) (novelty: 2)
• 2025-09-10 — RESULTS Act: 2026 — RESULTS Act (introduced): would require CMS to contract with a nonprofit maintaining a private-sector claims database to inform Medicare payment rates for widely available clinical diagnostic laboratory tests beginning January 1, 2028. (novelty: 3)
• 2026-07-02 — Revised Medical Criteria for Evaluating Cardiovascular Disorders: cross-connection with ssa-disability-listings: SSDI recipients qualify for Medicare after a waiting period, so SSA listing criteria affect the Medicare-eligible population. (novelty: 2)

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