Social Security and Medicare

Clergy Act

This act establishes a two-year window for members of the clergy who have opted out of Social Security and Medicare taxes (and are thus ineligible for benefits under those programs) to opt back in.

Under current law, certain ministers, members of religious orders, and Christian Science practitioners who object to participation in public insurance programs on religious or conscientious grounds may apply to the Internal Revenue Service (IRS) for an exemption from Social Security and Medicare taxes on ministerial earnings. Individuals who are approved for the exemption do not receive Social Security or Medicare benefits in retirement unless they have qualifying credits from other employment. The exemption is irrevocable.

Under the act, clergy members may choose to revoke their exemption by filing an application with the IRS by the due date of their federal income tax return for the second taxable year after December 31, 2028 (i.e., April 15, 2031, unless an individual obtains an extension to file their taxes). A clergy member may choose for the revocation to take effect in taxable year 2029 or taxable year 2030. A revocation under the act is permanent.

Clergy members who opt back in will generally need 10 years of covered employment (40 credits) to be eligible for Social Security and Medicare benefits, as is currently required for these programs.

The IRS must develop a plan to inform clergy members of their eligibility to revoke prior exemptions, pursuant to the act's changes.

Ending Improper Payments to Deceased People Act

This act permanently allows the Department of the Treasury to access certain death records maintained by the Social Security Administration (SSA) to help prevent and recover improper payments (e.g., payments to deceased individuals). The act also establishes evidentiary requirements the SSA must meet before identifying an individual as deceased.

Current law requires the SSA to share its Death Master File with the Do Not Pay system maintained by Treasury for three years. The act makes this requirement permanent. Treasury must enter into an agreement with the SSA related to Treasury's share of the cost of state death data.

The act also prohibits the SSA from recording a death in the master file unless the SSA has clear and convincing evidence that the individual should be presumed deceased. If an individual is incorrectly identified as deceased and provides the SSA with supporting documentation, the SSA may notify certain agencies that have access to the master file, including Treasury and federal or state agencies that provide or disburse federally funded benefits.

Improving Social Security's Service to Victims of Identity Theft Act

This act requires the Social Security Administration to provide a single point of contact for any individual whose Social Security number has been misused or whose Social Security card has been lost in transport. The point of contact must track cases to completion and coordinate with other units to resolve issues as quickly as possible.

The point of contact must consist of a team or subset of specially trained employees. Staffing may change provided there are procedures in place to ensure continuity of records and notify affected individuals when appropriate.

Social Security Child Protection Act of 2025

This bill directs the Social Security Administration to issue a new Social Security number to a child under the age of 14 if the child's Social Security card was lost or stolen while being mailed to the child.

Rural Community Hospital Demonstration Program Reauthorization

This bill extends the Rural Community Hospital Demonstration Program for an additional five years. The program tests the feasibility of cost-based reimbursement under Medicare for small rural hospitals that are too large to qualify for special payment as critical access hospitals.

The bill specifies that hospitals that participate in the program between December 30, 2024, and January 1, 2027, may continue to participate during the five-year extension period.

Choices for Increased Mobility Act of 2025

This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish specific billing codes under Medicare for certain materials used in ultralightweight manual wheelchairs.

Specifically, the CMS must establish at least two billing codes for the base of the wheelchair, with at least one code for a base with titanium or carbon fiber construction material and at least one code for a base without these materials. Suppliers receive the same payment under Medicare for these wheelchairs as would otherwise apply, but may bill beneficiaries for any difference between the payment and the actual charge for the wheelchair. The CMS may require suppliers to inform beneficiaries of their potential financial liability in these cases.

Claiming Age Clarity Act

This bill changes certain terms that are used by the Social Security Administration (SSA) to describe the ages at which a worker may claim Social Security retirement benefits.

First, the SSA must use minimum monthly benefit age instead of early eligibility age. This refers to the earliest age (62 under current law) at which a worker may claim benefits. (Currently, the benefit amount of a worker who claims benefits early is reduced to account for the longer period during which the worker is expected to receive benefits.)

Second, the SSA must use standard monthly benefit age instead of full retirement age and normal retirement age. These terms refer to the age at which a worker may claim benefits without a reduction in the benefit amount. (Currently, this age ranges from 65 to 67, depending on the worker's year of birth.)

Finally, the SSA must use the term maximum monthly benefit age for any reference to age 70 as the maximum age at which a worker may receive delayed retirement credits. The SSA may not use the term delayed retirement credit. These terms refer to the mechanism that increases the benefit amount of a worker who delays claiming benefits after reaching the full retirement age. (Currently, a worker receives a credit for each month between the full retirement age and age 70 that the worker delays claiming benefits. Each credit increases the benefit amount that the worker will receive after claiming benefits by a specified percentage.)

Hospital Inpatient Services Modernization Act

This bill extends the Acute Hospital Care at Home Program under Medicare and requires an additional study regarding the program. The program allows hospitals to treat certain patients from emergency departments or inpatient hospital beds at home.

Specifically, the bill extends the program through FY2030 and requires the Centers for Medicare & Medicaid Services to conduct a study of the program with respect to several metrics, including the quality of care, incurred costs, types of services, and demographics of patients under the program compared to inpatient settings.

Health Care Efficiency Through Flexibility Act

This bill delays certain requirements relating to the reporting of quality measures by accountable care organizations (ACOs) under the Medicare Shared Savings Program. It also requires the Centers for Medicare & Medicaid Services (CMS) to establish a pilot program that tests alternative digital reporting methods for ACOs.

The Medicare Shared Savings Program enables ACOs to receive payments for savings stemming from care coordination and management. In 2024, the CMS issued a rule requiring ACOs to report on quality measures using a certain electronic system beginning in 2025.

The bill allows ACOs to continue to use prior methods of reporting quality measures through 2029. Additionally, the CMS must establish a pilot program to test other digital reporting methods from 2028-2032; ACOs that participate in the pilot program are exempt from using other methods. The CMS must publicly post an analysis of the program and any related recommendations for using the tested methods.

Pre-Payment Fraud Prevention and Treasury Data Access Act

This bill expands efforts to identify, prevent, and recover improper payments of federal funds (e.g., overpayments, underpayments, payments to ineligible recipients).

Specifically, the Department of the Treasury must establish certain requirements that agencies must meet before directing Treasury to make a payment of federal funds. These pre-payment requirements must include verification of payee information, payment details, and fund availability. Further, agencies must, to the extent practicable, verify the accuracy of payee bank account information before directing Treasury to make a payment.

The bill also expands the Do Not Pay system, which provides agencies with access to centralized data for the purpose of verifying payee eligibility, and provides statutory authority for Treasury’s role as administrator of the system. The bill requires specified data assets to be added to the system and authorizes Treasury to (1) designate additional data assets for inclusion, and (2) access certain taxpayer and Social Security information for the system. The bill specifies that information obtained through the system may only be used to prevent and recover improper payments and establishes penalties for the unlawful disclosure of such information.

The bill explicitly requires executive agencies and state and local governments administering federally funded programs to screen payees against all appropriate Do Not Pay data assets and risk tools before making an award or directing a payment.

Finally, the bill establishes post-award reporting requirements for certain first-time fund recipients under federal programs for awards of $50,000 or more.

This joint resolution prohibits the Centers for Medicare & Medicaid Services (CMS) from testing a new Medicare payment model in certain states that involves a prior authorization process and the use of enhanced technology by third-party contractors to determine whether certain claims should be paid.

Specifically, the joint resolution nullifies a notice issued by the CMS on July 1, 2025, titled Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model. (On May 12, 2026, the Government Accountability Office issued a letter of opinion stating that this notice constituted an agency rule and is therefore subject to the Congressional Review Act.)

The CMS selected six states to participate in this model over a six-year period: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Under the model, contracted companies must process prior authorization requests (i.e., requests for coverage determinations before a service is furnished) for certain services using enhanced technology (e.g., artificial intelligence). Contracted companies are paid based on the share of resulting savings. The CMS aims to test the model's ability to produce accurate results while streamlining the prior authorization process for Medicare claims. The model is based in part on similar processes used for Medicare Advantage claims.

CMS began implementing the model on January 1, 2026. This joint resolution prohibits the CMS from continuing to do so.

This joint resolution nullifies the rule titled Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability, which was issued by the Centers for Medicare & Medicaid Services on June 25, 2025.

The rule makes several changes to enrollment requirements for health insurance exchanges, including (1) requiring annual open enrollment periods for all exchanges to begin by November 1 and end by December 31, (2) requiring all exchanges to conduct pre-enrollment verification of eligibility for at least 75% of new enrollments through special enrollment periods, and (3) prohibiting Deferred Action for Childhood Arrivals (DACA) recipients from enrolling in plans through exchanges or in state Basic Health Programs (state programs for certain low-income residents).

The rule also prohibits individual and small group health insurers from covering certain sex-trait modification procedures as an essential health benefit.

Improving Seniors' Timely Access to Care Act of 2025

This bill establishes several requirements and standards relating to prior authorization processes under Medicare Advantage (MA) plans.

Specifically, MA plans must (1) establish an electronic prior authorization program that meets specified standards; (2) annually submit to the CMS for publication specified prior authorization information, including the percentage of requests approved and the average response time; and (3) meet other standards, as set by the Centers for Medicare & Medicaid Services (CMS), relating to the quality and timeliness of prior authorization determinations.

The CMS and the Office of the National Coordinator for Health Information Technology must publish on the CMS' website a report that analyzes the information received from MA plans, the feasibility of implementing real-time decision making with respect to prior authorization requests, and the impact of decisions that are made using artificial intelligence on patient access.

Alzheimer's Screening and Prevention Act of 2025 or the ASAP Act

This bill provides for Medicare coverage of blood tests to screen for the early stages of Alzheimer’s disease or related dementias. Specifically, the bill provides for coverage of genomic sequencing blood or blood product tests, or other equivalent tests, that are approved by the Food and Drug Administration.

Ensuring Community Access to Pharmacist Services Act

This bill provides for permanent coverage under Medicare of certain pharmacist services.

Specifically, the bill provides for permanent coverage of testing and treatment services provided by pharmacists relating to (1) COVID-19, influenza, respiratory syncytial virus (RSV), and streptococcal pharyngitis (strep throat); and (2) other public health needs in relation to a declared public health emergency. (Similar authorities were temporarily granted during the COVID-19 public health emergency.) Such services must be provided in accordance with the applicable state laws governing pharmacists' scope of practice.

Provider Reimbursement Stability Act of 2026

This bill allows for larger annual adjustments to the Medicare physician fee schedule. It also requires the Centers for Medicare & Medicaid Services (CMS) to make certain corrections to compensate for expenditures under the fee schedule that exceed a certain amount in a given year, and it limits how much certain adjustment factors may vary each year.

Current law prohibits annual adjustments to the Medicare physician fee schedule that would result in a more than $20 million difference between the adjusted amount and the non-adjusted amount of total expenditures. The bill increases this threshold to $54.3 million beginning in 2027, with adjustments for inflation every five years beginning in 2032.

Additionally, for certain services, the bill requires the CMS to determine the difference between expenditures based on estimated utilization of the service and expenditures based on actual utilization. If this difference exceeds a certain percentage of total expenditures under the fee schedule, the CMS must reconcile this difference by adjusting payments for the following year. This requirement applies to services for which payment was bundled with another service and there was a separate or add-on payment during the previous year.

Finally, the CMS must update the prices and rates of each category of direct costs that affect payments (e.g., prices of equipment) at least every five years, with updates made to each category in the same year. The bill also prohibits the CMS from varying a certain adjustment factor by more than 2.5% each year.

Ensuring Patient Access to Critical Breakthrough Products Act

This bill provides for Medicare coverage of medical devices that are approved under the Food and Drug Administration (FDA) Breakthrough Devices Program. (Under the program, manufacturers work with the FDA to expedite the review and approval of certain medical devices that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating human diseases or conditions.)

The bill allows designated medical breakthrough devices to be temporarily covered under Medicare during a four-year transitional period. Manufacturers must apply to the Centers for Medicare & Medicaid Services (CMS) to receive this designation. Qualifying devices must (1) have received priority review from the FDA, (2) received premarket approval (if applicable) based on clinical data that includes data from Medicare beneficiaries, (3) already generally qualify for Medicare coverage, and (4) not present an undue risk of harm that outweighs potential clinical benefits for Medicare beneficiaries.

The CMS must approve or deny applications within six months of receipt and must provide an explanation in the case of a denial. In addition, the CMS must make permanent coverage decisions before the end of the transitional period upon a timely request to do so, as specified.

The bill provides funds through FY2030 for the CMS to implement the bill.

Medically Tailored Home-Delivered Meals Program Pilot Act

This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish a temporary program through which certain Medicare beneficiaries with diet-impacted diseases may receive medically tailored meals at home to reduce their rate of hospital readmissions.

Specifically, the CMS must select, upon application, at least 40 hospitals to participate in a six-year program to deliver medically tailored meals to qualifying individuals' homes. Participating hospitals must meet specified program integrity and quality of care metrics and certify that they are able to provide the required meals and associated medical nutrition therapy. Hospitals must have a physician, registered dietitian or nutrition professional, advanced practice nurse, or clinical social worker screen inpatients upon discharge from the hospital and every 12 weeks thereafter to determine whether these individuals qualify for the meal program.

In order to qualify for the program, individuals must have a diet-impacted disease (e.g., kidney disease), live at home, not be receiving extended care services or hospice care, be limited with respect to at least two activities of daily living, and meet any other criteria for high-risk readmissions (as determined by the CMS).

Seniors’ Access to Critical Medications Act of 2025

This bill temporarily expands flexibilities under the Stark law (i.e., the Physician Self-Referral Law) for certain physicians who dispense covered outpatient drugs under the Medicare prescription drug benefit at the physician's office location (e.g., through an integrated pharmacy). The Stark law generally prohibits physicians from referring patients to receive services that are payable under Medicare or Medicaid from entities in which the physician or an immediate family member has a financial relationship.

Specifically, the bill allows, from 2026-2030, physicians to dispense such drugs from the physician's office, including through in-person pickup by a caregiver or via mail, if (1) the physician prescribed the drug, (2) the beneficiary has an ongoing relationship with the physician, (3) the beneficiary had at least one face-to-face visit with the physician in the prior year, and (4) the physician bills for the drug. These requirements also apply to physicians within the same group practice.

The Government Accountability Office must report on pharmacies or pharmacy networks that dispense significantly more covered drugs under the Medicare prescription drug benefit after the bill's enactment, the extent to which such pharmacies and networks are owned by physicians or integrated into physician practices, and the common characteristics of these types of arrangements.

Apples to Apples Comparison Act of 2025

This bill requires additional reporting and disclosures regarding Medicare enrollment and expenditures.

Specifically, the bill requires the Centers for Medicare & Medicaid Services to annually report on and publish information on its website regarding expenditures for Medicare hospital services and medical services, the Medicare prescription drug benefit, and Medicare Advantage (MA), including for those who are enrolled in one program but not others or have supplemental insurance. This information must be broken down by county and metropolitan statistical area for each month over the prior 10-year period and for each month over the next 5-year period.

In addition, the Medicare Payment Advisory Commission must annually analyze and report on expenditures for Medicare beneficiaries who have an MA plan compared to those who do not have an MA plan. The Boards of Trustees for Medicare must annually report on expenditures for (1) Medicare beneficiaries who have either hospital services or medical services but not both, and (2) Medicare beneficiaries who have both hospital and medical services but do not have an MA plan.

Words Matter Act of 2025

This bill removes outdated terminology in specified statutes by replacing references to mentally retarded and mental retardation with intellectual disability.

Medicare Access to Rural Anesthesiology Act

This bill modifies the Medicare payment methodology for anesthesiologists in rural hospitals.

Specifically, the bill provides that payment must be made on a reasonable cost basis for anesthesiologists in rural hospitals and critical access hospitals that have no more than 800 surgical procedures requiring anesthesia services per year (or a higher number set by the Centers for Medicare & Medicaid Services).

Rural Patient Monitoring Access Act or the RPM Access Act

This bill conditions Medicare payment for remote patient monitoring services on certain requirements.

Specifically, the bill conditions payment on (1) the ability of certain health care practitioners to be available in real time to respond to any detected anomalies; (2) the use of a system that can transmit relevant data in a format that is compatible with electronic health records, as needed; and (3) the reporting of such data, as required by the Centers for Medicare & Medicaid Services (CMS), to evaluate any cost savings as a result of such services.

The bill also establishes a floor for certain payment calculations with respect to such services.

The CMS must report on cost savings realized and expenses incurred from the use of such services over a four-year period.