Social Security and Medicare

Veteran Caregiver Reeducation, Reemployment, and Retirement Act

This bill expands support and assistance provided to family caregivers under the Program of Comprehensive Assistance for Family Caregivers administered by the Department of Veterans Affairs (VA).

First, the bill extends the period of medical care coverage for primary family caregivers to include the 180-day period following the removal of their designation as a caregiver under the program, unless such individuals (1) were dismissed from the program for fraud, abuse, or mistreatment; or (2) are entitled to Medicare.

Next, the VA must provide bereavement counseling and support to family caregivers following the death of a veteran receiving care under the program. The VA must also provide retirement planning services to primary family caregivers and study the feasibility and advisability of establishing a retirement plan or retirement savings for caregivers.

Further, unless they were discharged for fraud, abuse, or mistreatment, the VA must provide to primary family caregivers (1) assistance returning to the workforce upon discharge or dismissal from the program, (2) support in transitioning from caregiving, and (3) specified employment assistance during their tenure as a caregiver and for the following 180-days.

The VA must partner with the Department of Labor to study and report on the feasibility and advisability of conducting a program to assist primary caregivers in returning to the workforce.

Finally, the Government Accountability Office must report on the VA’s efforts supporting family caregivers in transitioning from caregiving.

Joe Fiandra Access to Home Infusion Act of 2025

This bill provides for Medicare coverage of certain home infusion drugs that are administered by health care professionals at a beneficiary’s home.

Specifically, the bill provides for coverage of external infusion pumps and associated home infusion drugs for which (1) the prescription requires that the drug be administered by or under the supervision of a health care professional, (2) a qualified home infusion therapy supplier administers or supervises the administration of the drug at the beneficiary's home, and (3) the prescription requires that the drug be infused at least 12 times per year in a manner that requires the use of an external infusion pump.

Improving Home Dialysis Act of 2026

This bill provides for Medicare coverage of staff-assisted home dialysis respite care and renal mental health services that are furnished at the home of a beneficiary with end-stage renal disease.

Coordinating Care for Senior Veterans and Wounded Warriors Act

This bill requires the Department of Veterans Affairs (VA) to implement a three-year pilot program to coordinate, navigate, and manage care and benefits for veterans who are enrolled in both the Medicare program and the VA health care system.

DME Scammer Prevention Act of 2026

This bill establishes requirements relating to potentially fraudulent billing for certain durable medical equipment under Medicare.

Specifically, the bill establishes requirements relating to billing for items that are on the Master List of Durable Medical Equipment, Prosthetics, Orthotics and Supplies. (The master list includes items that the Centers for Medicare & Medicaid Services has identified as posing certain fiscal vulnerabilities and therefore require additional conditions for payments to be made, such as prior authorization.)

The bill requires claims for such items to be filed electronically and within 90 days of when the items were furnished. The Government Accountability Office must report on the technology used by Medicare administrative contractors to identify fraudulent claims with respect to such items.

Protecting Seniors and Stopping Fraudsters Act

This bill establishes additional requirements for hospice programs and home health agencies under Medicare, particularly in relation to oversight and transparency.

Specifically, the bill subjects hospice programs to revalidation within one year if the program (1) is located in a state in which new hospice programs are subject to enhanced oversight, as determined by the Centers for Medicare & Medicaid Services (CMS); and (2) has not been subject to revalidation over the previous 18 months.

Additionally, hospice programs and home health agencies that are newly enrolled, have undergone a change in ownership, or have had billing privileges reactivated must undergo surveys at least once every 12 months over the 36-month period following their change in status. The bill also requires hospice programs and home health agencies that do not submit required data to the CMS or that have an unusual rate of admissions or discharges to undergo additional surveys. The bill also subjects hospice programs and home health agencies that fail to submit required data to the CMS to larger payment reductions beginning in FY2029.

The CMS must identify hospice programs and home health agencies that are located in a state or county for which the total number of such programs and agencies significantly exceeds the totals for the previous year. The CMS must flag these programs and agencies as being at extreme risk of fraud and institute additional screening requirements, including fingerprinting requirements for certain personnel.

Medicare Advantage MLR Transparency Act

This bill requires Medicare Advantage (MA) organizations to publish certain information regarding revenue and expenses and to present information about benefits in a certain manner.

Specifically, MA organizations must submit to the Centers for Medicare & Medicaid Services and publish on their websites information about the revenue received under each offered plan and a breakdown of related expenses, including for items other than claims. MA organizations must also, to the extent practicable, present electronic information about plan benefits to beneficiaries in a manner that is similar to how such information is presented by private insurers.

Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act

This bill allows, beginning in 2028, for Medicare coverage and payment for multi-cancer early detection screening tests that are approved by the Food and Drug Administration and that are used to screen for cancer across many cancer types, if the Centers for Medicare & Medicaid Services determines such coverage is appropriate. Coverage is limited to those under a certain age (age 68 in 2028, increased by one year every year thereafter) and to one test every 11 months.

Medicare Patient Access and Practice Stabilization Act of 2025

This bill increases certain payment adjustments under the Medicare physician fee schedule for services furnished between April 1, 2025, and January 1, 2026.

Chiropractic Medicare Coverage Modernization Act of 2025

This bill expands Medicare coverage of chiropractic services to include all services provided by chiropractors, rather than only subluxation corrections through manual manipulation of the spine.

Protecting Americans’ Social Security Data Act

This bill prohibits political appointees and special government employees from accessing Social Security data systems that contain personally identifiable information about Social Security beneficiaries.

Specifically, political appointees and special government employees may not access systems maintained by the Social Security Administration (SSA) that issue or record Social Security account numbers, that are used to determine eligibility for or to pay Social Security benefits, or that otherwise contain personally identifiable information about individuals receiving or applying for benefits.

The bill also establishes a civil right of action for an individual whose information was negligently accessed or disclosed in violation of these provisions. The individual may bring suit against the United States if the violator was a U.S. employee or officer, or against the violator if they were not a U.S. employee or officer. Such a claim must be brought within two years of the affected individual’s discovery of the violation. Upon a finding of liability, defendants are liable for specified monetary damages.

If an individual is criminally charged or subject to proposed disciplinary or adverse action by a federal or state agency for having accessed or disclosed information in violation of these provisions, SSA must notify the individual whose information was accessed or disclosed of the violation as soon as practicable.

Finally, the bill requires the SSA Office of the Inspector General to investigate and report to Congress on any unauthorized access to or disclosure of information in a beneficiary data system.

Workplace Violence Prevention for Health Care and Social Service Workers Act

This bill requires the Department of Labor to address workplace violence in health care, social service, and similar sectors.

Specifically, Labor must issue an occupational safety and health standard that requires certain employers to take actions to protect workers and other personnel from workplace violence. The standard applies to employers in the health care sector, in the social service sector, and in sectors that conduct activities similar to those in the health care and social service sectors. Among other elements, the standard must require each employer to (1) develop a workplace violence prevention plan, (2) promptly investigate incidents of workplace violence, and (3) provide relevant training and education to employees.

The bill requires certain hospitals and skilled nursing facilities to comply with this standard as a condition of Medicare participation.

Medicare Dental, Vision, and Hearing Benefit Act of 2025

This bill provides for Medicare coverage of dental, vision, and hearing care. Coverage includes (1) routine dental cleanings and exams, basic and major dental services, emergency dental care, and dentures; (2) routine eye exams, eyeglasses, and contact lenses; and (3) routine hearing exams, hearing aids, and exams for hearing aids. With respect to such care, the bill establishes special payment rules, limitations, and coinsurance requirements.

Keeping Our Field Offices Open Act

This bill temporarily prohibits the closure or consolidation of, or other limitation of access to, Social Security Administration (SSA) offices and stations, and sets forth procedural requirements for future changes to office and station availability.

Specifically, the bill prohibits through at least January 21, 2029, the closure or consolidation of, or other limitation of access to, SSA field offices, hearing offices, and resident stations. On or after that date, SSA must submit a report to Congress justifying its process for selecting stations and offices to be closed, consolidated, or limited. The prohibition is lifted 180 days after the submission of such report.

The bill also sets forth requirements that must be met before SSA may close, consolidate, or otherwise limit access to an office or station after the initial moratorium expires. At least 120 days before such a change takes effect, SSA must provide public notice to individuals in affected areas, including information on how lost access to SSA services will be replaced. SSA must also conduct at least two public hearings on each such change.

Further, SSA must provide a hearing to any individual who makes a timely showing that a determination to close, consolidate, or limit an office or station is arbitrary, capricious, or deficient in another specified manner.

Finally, a closure, consolidation, or limitation may not result in the total number of SSA offices or stations falling below the number of such offices or stations in operation on January 20, 2025.

Medicare for All Act

This bill establishes a national health insurance program that is administered by the Department of Health and Human Services (HHS).

Among other requirements, the program must (1) cover all U.S. residents; (2) provide for automatic enrollment of individuals upon birth or residency in the United States; and (3) cover items and services that are medically necessary or appropriate to maintain health or to diagnose, treat, or rehabilitate a health condition, including hospital services, prescription drugs, mental health and substance abuse treatment, dental and vision services, long-term care, gender affirming care, and reproductive care, including contraception and abortions.

The bill prohibits cost-sharing (e.g., deductibles, coinsurance, and copayments) and other charges for covered services. Additionally, private health insurers and employers may only offer coverage that is supplemental to, and not duplicative of, benefits provided under the program.

Health insurance exchanges and specified federal health programs terminate upon program implementation. However, the program does not affect coverage provided through the Department of Veterans Affairs or the Indian Health Service.

The bill also establishes a series of implementing provisions relating to (1) health care provider participation; (2) HHS administration; and (3) payments and costs, including the requirement that HHS negotiate prices for prescription drugs.

Individuals who are age 18 or younger, age 55 or older, or already enrolled in Medicare may enroll in the program starting one year after enactment of this bill; other individuals may buy into the program at this time. The program must be fully implemented two years after enactment.

Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN Act

This bill reduces cost-sharing and prohibits the imposition of certain utilization requirements under the Medicare prescription drug benefit for certain non-opioid pain management drugs.

Specifically, the bill requires such drugs to be covered without a deductible and to be placed on the lowest cost-sharing tier (if any). The bill also prohibits the imposition of prior authorization requirements (i.e., requiring prior approval from a plan) or step therapy requirements (i.e., requiring the use of alternative drugs before a drug is covered under a plan) with respect to such drugs.

Stop the Wait Act of 2025

This bill phases out the initial waiting period for Social Security Disability Insurance (SSDI) benefits and eliminates the waiting period for certain disabled individuals to become eligible for Medicare.

Under current law, individuals generally must wait five months after the onset of disability to begin receiving SSDI benefits. The bill would gradually reduce this waiting period before eliminating it entirely in the year 2030.

Further, the bill would eliminate the 24-month waiting period for certain disabled workers and other individuals to become eligible for Medicare. Under current law, individuals under the age of 65 may generally enroll in Medicare after they have been eligible for SSDI or Social Security child’s, widow’s, or widower’s benefits by reason of disability for 24 months. The bill would eliminate this waiting period for individuals for whom the annual cost of certain medical insurance would exceed a specified percentage of their household income (i.e., those who cannot afford minimum essential coverage). Medicare eligibility for these individuals must be available retroactively to the first month that an individual qualified for SSDI or Social Security child’s, widow’s, or widower’s benefits by reason of disability.

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.

This bill lengthens the amount of time for which drug products must have market approval in order for the products to qualify for negotiation under the Medicare Drug Price Negotiation Program.

The Medicare Drug Price Negotiation Program requires the Centers for Medicare & Medicaid Services to negotiate the prices of certain prescription drugs under Medicare beginning in 2026. Among other requirements, drugs must have had market approval for at least 7 years (for drug products) or 11 years (for biologics) to qualify for negotiation.

The bill modifies these provisions so as to require drug products to also have had at least 11 years of market approval in order to qualify for negotiation.

The bill's changes apply retroactively.

Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act

This bill allows, beginning in 2028, for Medicare coverage and payment for multi-cancer early detection screening tests that are approved by the Food and Drug Administration and that are used to screen for cancer across many cancer types, if the Centers for Medicare & Medicaid Services determines such coverage is appropriate. Coverage is limited to those under a certain age (age 68 in 2028, increased by one year every year thereafter) and to one test every 11 months.