Social Security and Medicare

Protecting America’s Seniors’ Access to Care Act

This bill prohibits administration, implementation, or enforcement of the rule titled Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting, which was issued by the Centers for Medicare & Medicaid Services on May 10, 2024.

Specifically, the bill prohibits administration, implementation, or enforcement of provisions that, among other changes, (1) establish minimum staffing standards for nurses in Medicare and Medicaid long-term care facilities, including requiring a nurse to be onsite 24/7 and requiring a minimum of 3.48 total nurse staffing hours per resident per day; and (2) require state Medicaid programs to report on payments to direct care workers and support staff of nursing facilities and intermediate care facilities for individuals with intellectual disabilities.

Acupuncture for Our Seniors Act of 2025

This bill provides for Medicare coverage of acupuncturist services, including those provided by a physician (as authorized under state law).

This bill limits the amount of coinsurance that may be assessed under Medicare for services performed in ambulatory surgical centers.

Specifically, if the applicable coinsurance amount exceeds the inpatient hospital deductible, the Centers for Medicare & Medicaid Services must reduce the coinsurance amount so that it is equal to the amount of the deductible and pay the difference to the service provider.

Rebuild America’s Health Care Schools Act of 2025

This bill allows hospitals to receive reimbursement under Medicare for certain costs associated with training nursing and allied health students in settings other than the hospital itself.

Currently, hospitals may receive reimbursement under Medicare for the reasonable costs associated with training nursing and allied health students if certain conditions are met; the criteria vary depending on whether the students are enrolled in an educational program that is operated by the hospital or another entity. If the students are part of a program that is operated by another entity, the training must occur at the hospital itself or in areas immediately surrounding the hospital in order to qualify for reimbursement (among other requirements). The bill allows hospitals to receive reimbursement for these costs if the training is conducted at an entity that is related to the hospital (i.e., common ownership or control).

The bill requires the Centers for Medicare & Medicaid Services (CMS) to update regulations to reflect these changes. Additionally, the CMS may not recoup or reduce payments to hospitals with respect to costs that are allowed under the bill and must refund any such recoupments or reductions that occurred during the six-year period prior to the bill's enactment.

Strengthening Medicare for Patients and Providers Act

This bill modifies certain adjustments to payment amounts under the Medicare physician fee schedule.

Payment amounts under the Medicare physician fee schedule are based on a service's relative value, a conversion factor, and a geographic adjustment factor. Current law provides for separate conversion factors for physicians that are qualifying participants in advanced alternative payment models (also known as qualifying APM participants) and for other physicians beginning in 2026, with an annual update of 0.75% and 0.25%, respectively.

The bill replaces the separate conversion factors for qualifying APM participants and other physicians with a single conversion factor and provides for an update that is equal to the annual percentage increase in the Medicare Economic Index, beginning in 2026. (The Medicare Economic Index is a specialized index that is generally used to determine allowed charges for physician services based on annual price changes.)

Optimizing Research Progress Hope And New Cures Act or the ORPHAN Cures Act

This bill modifies certain provisions under the Medicare Drug Price Negotiation Program with respect to orphan drugs.

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 program does not apply to orphan drugs that are approved to treat only one rare disease or condition.

The bill modifies these provisions so as to exclude any period in which a drug was an orphan drug from market approval calculations. It also excludes orphan drugs that are approved to treat more than one rare disease or condition from the program.

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, home- and community-based 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, with the exception of prescription drugs. 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, TRICARE, or the Indian Health Service. Additionally, state Medicaid programs must cover certain institutional long-term care services.

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 and establish a formulary.

Individuals who are age 18 or younger may enroll in the program starting one year after enactment of this bill; other individuals may buy into a transitional plan or an expanded Medicare program at this time, depending on age. The bill's program must be fully implemented four years after enactment.

Consequences for Social Security Fraud Act

This bill adds additional criminal offences to the grounds upon which a non-U.S. national (alien under federal law) may be barred from admission into the United States or deported. Specifically, an individual who has been convicted of, or admits to committing, Social Security fraud, identification document fraud, or fraud related to COVID-19 financial assistance programs is inadmissible or deportable under the bill.

Reducing Medically Unnecessary Delays in Care Act of 2025

This bill requires Medicare coverage decisions, including prior authorization requirements and adverse coverage decisions, to be based on written clinical criteria that is developed in consultation with physicians.

Save Medicare Act

This bill renames Medicare Advantage (MA) as the Alternative Private Health Plan program. It also establishes civil penalties for entities that continue to advertise MA plans with Medicare in the title.

Land And Social Security Optimization Act or the LASSO Act

This bill requires 10% of revenue generated by public lands, including submerged lands on the Outer Continental Shelf, under the jurisdiction of the Department of the Interior and the Forest Service to be deposited into the Federal Old-Age and Survivors Insurance Trust Fund, which is used to pay Social Security benefits to retirees and their families and to survivors of deceased workers.

Medicare Dental Benefit Act of 2026

This bill provides for Medicare coverage of dental and oral health services, including routine diagnostic and preventive services, basic and major dental services, and emergency care; dental prostheses are also covered. Currently, such services are excluded from Medicare coverage.

Rural Hospital Support Act

This bill modifies and extends certain payment adjustments for rural hospitals under Medicare's inpatient prospective payment system.

Specifically, the bill indexes payment adjustments for sole community hospitals and Medicare-dependent hospitals to FY2016 operating costs, if it results in higher payments for such hospitals. The bill also makes payment adjustments for Medicare-dependent hospitals and low-volume hospitals permanent (the adjustments currently expire on March 31, 2025).