Adrian Smith

PI Post Acute Access Act

This bill allows for separate payment under Medicare to skilled nursing facilities for items and services that are needed to administer intravenous immune globin (IVIG) to patients with primary immune deficiency diseases (rare genetic disorders that impair the immune system and increase vulnerability for other infections).

SOS: Sustaining Outpatient Services Act

This bill allows for payment under the Medicare prospective payment system for hospital outpatient department services of certain items and services that are furnished at off-campus outpatient departments. Specifically, the bill allows for payment of items and services for which payments to physician specialists (under the Medicare physician fee schedule) did not exceed $2 million during the previous year.

ACO Assignment Improvement Act of 2025

This bill establishes additional requirements for assigning Medicare fee-for-service beneficiaries to accountable care organizations (ACOs) under the Medicare shared savings program. Under current law, the program enables ACOs to receive payments for savings stemming from care coordination and management.

The bill requires the basis for assignment to reflect beneficiaries' utilization of not only primary care services provided by ACO physicians, but also those provided by other ACO practitioners—specifically, physician assistants, nurse practitioners, and clinical nurse specialists.

Rural Veterinary Workforce Act

This bill excludes from gross income, for federal tax purposes, payments received pursuant to the Veterinary Medicine Loan Repayment Program or any state loan repayment or loan forgiveness program that is intended to provide for increased access to veterinary services. (The Veterinary Medicine Loan Repayment Program is a Department of Agriculture program that repays a portion of the student loans of veterinarians who provide short-term services in designated veterinary shortage areas.)

Maintaining and Enhancing Hydroelectricity and River Restoration Act

This bill establishes a new investment tax credit in the amount of 30% of the basis of any hydropower improvement property.

The bill defines hydropower improvement property as property that

• adds or improves fish passage at a qualified dam;

• maintains or improves the quality of the water retained or released by a qualified dam;

• promotes downstream sediment transport and habitat maintenance;

• upgrades, repairs, or reconstructs a qualified dam to meet safety and security standards;

• improves public uses of, and access to, public waterways impacted by a qualified dam;

• removes an obsolete river obstruction; or

• places into service an approved remote dam.

Further, written approval for hydropower improvement property must be obtained from the Federal Energy Regulatory Commission or state or local officials prior to January 1, 2032.

The bill also allows an election to claim the investment tax credit for qualified progress expenses for some types of hydropower improvement property in advance of such property being placed into service. Any investment tax credit amount claimed for qualified progress expenses reduces the amount of the investment tax credit that may be claimed once the hydropower improvement property is placed into service.

The bill authorizes certain entities, including tax-exempt and governmental entities, to treat the investment tax credit for hydropower improvement property as a payment of tax and receive a refund of any overpayment (also known as elective pay).

Finally, the investment tax credit for hydropower improvement property may be transferred (i.e., sold).

Undertaking Negotiations on Investment and Trade for Economic Dynamism Act or the UNITED Act

This bill grants certain authorities to the President for entering into a comprehensive trade agreement between the United States and the United Kingdom (UK).

Specifically, the bill directs the President to seek to initiate negotiations with the UK regarding tariff and nontariff barriers affecting any industry, product, or service sector.

The bill authorizes the President to enter into a comprehensive trade agreement with the UK, with such authority expiring on March 1, 2029. Further, the President may proclaim a modification or continuance of any existing duty or a continuance of existing excise or duty-free treatment to carry out an agreement, with certain limitations.

The bill also requires the President to consult with and notify Congress regarding the intention of the President to enter into an agreement or make a proclamation.

North Platte Canteen Congressional Gold Medal Act

This bill provides for the award of a Congressional Gold Medal to recognize the individuals and communities that provided financial and other support for the North Platte Canteen in North Platte, Nebraska, during World War II.

Medicare IVIG Access Enhancement Act of 2025

This bill provides for Medicare coverage of in-home administration of intravenous immune globulin to treat chronic inflammatory demyelinating polyneuropathy (CIDP) or multifocal motor neuropathy. (CIDP is an autoimmune condition that causes symptoms such as muscle weakness and numbness; multifocal motor neuropathy is a variant of CIDP that only causes asymmetric muscle weakness.)

Educational Choice for Children Act of 2025

This bill establishes a nonrefundable tax credit for contributions (cash or stock) made by an individual to a tax-exempt organization that provides scholarships for qualified elementary and secondary school expenses to eligible students (scholarship granting organization), subject to limitations.

Under the bill, the tax credit is limited to the greater of $5,000 or 10% of adjusted gross income.

Further, the bill establishes a $5 billion annual volume cap (for 2025-2028) for the tax credit (which may be increased under certain circumstances). The volume cap is allocated by the Department of the Treasury for the tax credit on a first-come, first-serve basis (based on the contribution date). However, under the bill, 10% of the volume cap must be divided evenly among states for allocation to individuals residing in those states.

The bill allows any portion of the tax credit that exceeds the individual’s tax liability (less certain other tax credits) to be carried forward for up to five tax years.

The bill also

• establishes specific requirements for a scholarship granting organization,

• requires a scholarship granting organization to distribute all contributions within a specific timeframe (exceptions apply), and

• excludes from gross income scholarships received by an individual from a scholarship granting organization.

Finally, the bill prohibits federal, state, and local government entities, officers, and employees from imposing requirements that prevent the use of scholarship funds for private or religious elementary or secondary education expenses or discouraging the use of scholarship funds at such education institutions.

Critical Access Hospital Relief Act of 2025

This bill repeals the 96-hour physician-certification requirement for inpatient critical access hospital services under Medicare. Under current law, as a condition for Medicare payment for such services, a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital.

Fostering Autonomy in Independent Returns by Prohibiting Redundant and Extralegal Programs Act of 2025 or the FAIR PREP Act of 2025

This bill prohibits the Internal Revenue Service (IRS) from preparing federal tax returns or refund claims, with some exceptions. The bill specifically prohibits the preparation of federal income tax returns or refund claims through the IRS’s Direct File program. (The Direct File program currently allows qualified taxpayers in 25 participating states to prepare and electronically file free federal tax returns through a portal on the IRS’s website.)

The bill defines prepare with respect to federal tax returns and refund claims as (1) the completion (in whole or in part) of any form or schedule for the purpose of calculating federal taxes or refunds, and (2) the filing (either electronically or on paper) of such federal tax returns or refund claims.

However, under the bill, federal and state tax returns and refund claims may be prepared through the IRS’s Free File program (a program that allows certain taxpayers to prepare and file free federal and state income tax returns using third-party tax-preparation software) or the Volunteer Income Tax Assistance grant program (through which the IRS partners with local community organizations to help low-income and disabled individuals and persons with limited English proficiency prepare and file free federal and state income tax returns).

Further, the Department of the Treasury may not award grants or enter into contracts or other transactions for the development or operation of an electronic tax preparation service.