Adrian Smith

Comprehensive Alternative Response for Emergencies Act of 2025 or the CARE Act of 2025

This bill requires the Center for Medicare and Medicaid Innovation (CMMI) to test a five-year model that provides for Medicare payment for ground ambulance services that do not result in the transport of the patient.

Under the model, Medicare payment may be furnished for ground ambulance services when an ambulance is dispatched in response to an emergency medical call but the ambulance does not end up transporting the patient. Payment rates under the model must generally align with the payment rates that apply when there is an actual transport.

The Government Accountability Office must report on the general access of Medicare beneficiaries to emergency medical services, including the impact of the model on beneficiary access and outcomes.

Heat Workforce Standards Act of 2025

This bill prohibits the Occupational Safety and Health Administration (OSHA) from finalizing, implementing, or enforcing a safety standard requiring certain employers to create a heat injury and illness prevention plan to evaluate and control heat hazards in their workplaces.

Specifically, OSHA is prohibited from finalizing the proposed rule titled Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings, which was published on August 30, 2024, or any substantially similar standard. The proposed standard generally applies to employers conducting outdoor and indoor work in all general industry, construction, maritime, and agriculture sectors where OSHA has jurisdiction. Employers must develop plans in accordance with the specified standards to address employee exposures to heat indexes at or above 80 degrees (initial heat trigger) or 90 degrees (high heat trigger) Fahrenheit.

As background, the Occupational Safety and Health Act of 1970 generally requires employers to provide their employees with a place of employment that is free from recognized hazards that are causing or likely to cause death or serious harm to employees. OSHA conducts workplace inspections and cites employers that fail to satisfy these requirements. Currently, OSHA does not have specific heat exposure standards; however, OSHA has historically used its general authority to cite employers for violations involving excessive heat, including through a National Emphasis Program that focuses on indoor and outdoor heat exposure in industries that have the highest risks.

Firearm Access During Shutdowns Act

This bill requires various federal agencies to continue certain operations, functions, and services related to firearms during a government shutdown.

The bill applies to

• the Federal Bureau of Investigation's National Instant Criminal Background Check System, including the processing of background checks in support of the operations of the Directorate of Enforcement Programs and Services of the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF);

• the ATF's Directorate of Enforcement Programs and Services;

• the activities of the Department of Commerce's Bureau of Industry and Security relating to firearms and firearm-related products, including activities related to processing of applications for export licenses; and

• the activities of the Department of State's Directorate of Defense Trade Controls relating to firearms and firearm-related products, including activities related to processing of applications for export licenses.

Under the bill, (1) these operations, functions, and services are deemed to relate to an emergency involving the safety of human life or the protection of property; and (2) employees carrying out the operations, functions, and services are deemed to be excepted employees. (Under an exception in the Antideficiency Act, an employee whose duties involve the safety of human life or the protection of property may be required to work during a government shutdown. Employees who are required to work during a government shutdown because they fall under this or other exceptions are known as excepted employees.)

This resolution supports the designation of National Rural Health Day.

Innovative Feed Enhancement and Economic Development Act of 2025 or the Innovative FEED Act of 2025

This bill provides for the regulation of zootechnical animal food substances as food additives.

The bill defines zootechnical animal food substance as a substance that is added to the food or drinking water of animals and that affects only the animal's gastrointestinal tract, with the intended purpose of affecting the byproducts of the animal's digestion, reducing foodborne pathogens, or altering the animal's gastrointestinal biome.

The definition does not include substances that are used to treat or prevent diseases in animals, hormones, or active ingredients of animal drugs. Labels for zootechnical animal food substances must include a disclaimer that the substance may not be used to treat or prevent diseases in animals.

This bill designates the facility of the United States Postal Service located at 1201 Calvert Street in Lincoln, Nebraska, as the "Commodore Dixie Kiefer Memorial Post Office Building".

Stamp Out Veterans Medical Debt Act

This bill requires the U.S. Postal Service to issue and sell a Veterans Medical Debt Relief Stamp to help pay medical debt incurred by veterans for hospital care, medicals services, and extended care services furnished by the Department of Veterans Affairs, including through the Veterans Community Care Program.

USS Frank E. Evans Act

This bill requires the Department of Defense to authorize inclusion on the Vietnam Veterans Memorial Wall in the District of Columbia of the names of the 74 crew members of the USS Frank E. Evans killed on June 3, 1969.

This bill expands the authority of U.S. Customs and Border Protection (CBP) to provide information to certain persons (e.g., trademark or copyright owners) regarding suspected violations of intellectual property rights in trade.

Under current law, if CBP suspects that merchandise is being imported in violation of certain trademark and copyright laws, it may request assistance from specified persons when determining whether the merchandise is imported in violation of these laws. To permit the party to conduct examination and testing, CBP must provide them with specified information that appears on the merchandise and its packaging and labels.

This bill (1) expands the definition of person to allow CBP to request assistance from any other appropriate party with an interest in the imported merchandise, and (2) expands the scope of information that CBP is authorized to share with others to include information on and images of packing materials and containers.

The bill allows CBP to request this assistance if it has a reasonable suspicion (currently, suspects) that the merchandise being imported is in violation of certain trademark and copyright laws.

Additionally, CBP may provide a person with nonpublic information about the imported merchandise that was generated by an online marketplace or similar market platform, express consignment operator, freight forwarder, or any other entity that plays a role in the sale, importation, or facilitation of the merchandise into the United States and has been provided to, shared with, or obtained by CBP. CBP must provide the person with notification of the transmitted information.

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.

Improving Access to Medicare Coverage Act of 2025

This bill deems an individual receiving outpatient observation services in a hospital as an inpatient for purposes of satisfying the three-day inpatient hospital-stay requirement with respect to Medicare coverage of skilled nursing facility (SNF) services. (Generally, individuals must have been an inpatient at a hospital for at least three days in order to qualify for SNF services. An individual's time spent under observation at a hospital for purposes of determining whether the individual should be admitted does not count towards this requirement.)

John W. Walsh Alpha-1 Home Infusion Act of 2025

This bill provides for Medicare coverage of treatment for alpha-1 antitrypsin (AAT) deficiency (a protein deficiency that raises the risk of lung and other diseases). Specifically, the bill provides for coverage of at-home augmentation therapy for beneficiaries with emphysema as a result of severe hereditary AAT deficiency. Treatment must be provided through qualified home infusion therapy suppliers; beneficiaries must be under the care of a physician, nurse practitioner, or physician assistant.

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.

Fair and Accountable IRS Reviews Act

This bill provides that an Internal Revenue Service (IRS) employee’s immediate supervisor for purposes of approving certain federal tax penalties is the person to whom such employee reports. The bill also provides that an immediate supervisor’s approval of certain federal tax penalties must be obtained (in writing) before any written communication related to such penalties is sent to the taxpayer.

As background, current law requires that the initial determination by an IRS employee to assess certain federal tax penalties be approved (in writing) by such employee’s immediate supervisor (or a designated higher-level official). Under IRS regulations, an immediate supervisor is any individual with responsibility to review another individual’s proposed federal tax penalties (without such proposal being subject to an intermediary’s approval). The IRS regulations also establish requirements for when such approval must be obtained based on whether the federal tax penalty is subject to pre-assessment review or raised in Tax Court proceedings.

This resolution (1) condemns the assassination of Charles "Charlie" James Kirk and all forms of political violence; and (2) honors the life, leadership, and legacy of Charlie Kirk.