Emily Randall

Gas-Operated Semi-Automatic Firearms Exclusion Act or the GOSAFE Act

This bill establishes a framework to regulate gas-operated semiautomatic firearms and large capacity ammunition feeding devices under federal firearms laws.

First, the bill generally prohibits the import, sale, manufacture, transfer, receipt, or possession of

• a firearm that is or is modified to operate as a prohibited gas-operated semiautomatic firearm;

• a combination of parts that modify or can be assembled into a prohibited gas-operated semiautomatic firearm, or that produce an unlawful gas-operated semiautomatic cycling action;

• a device or combination of parts designed to materially increase the rate of fire of a semiautomatic firearm; or

• a firearm that is modified to materially increase the rate of fire.

Second, the bill generally prohibits (1) the import, sale, manufacture, transfer, or receipt of a large capacity ammunition feeding device; or (2) the possession of a large capacity ammunition feeding device manufactured after the date of enactment.

A violation is subject to criminal penalties—a fine, a prison term of up to 12 months, or both, for each violation.

In addition, an individual who possesses a prohibited gas-operated semiautomatic firearm during a federal felony offense is subject to additional penalties—a fine, a mandatory minimum prison term of two years, or both.

Finally, the bill allows a state or local government to use Edward Byrne Memorial Justice Assistance Grant Program funds to compensate individuals who surrender gas-operated semiautomatic firearms and large capacity ammunition feeding devices under a buy-back program.

Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2025

This bill requires hospitals to implement and submit to the Department of Health and Human Services (HHS) a staffing plan that complies with specified minimum nurse-to-patient ratios by unit. Hospitals must post a notice regarding nurse-to-patient ratios in each unit and maintain records of actual ratios for each shift in each unit. The bill also requires hospitals to follow certain procedures regarding how ratios are determined, and other staff are prohibited from performing nurse functions unless specifically authorized within a state's scope of practice rules.

HHS must adjust Medicare payments to hospitals to cover additional costs attributable to compliance with these ratios.

Nurses may object to, or refuse to participate in, an assignment if it would violate minimum ratios or if they are not prepared by education or experience to fulfill the assignment without compromising the safety of a patient or jeopardizing their nurse's license. Hospitals may not (1) take adverse actions against a nurse based on the nurse's reasonable refusal to accept an assignment; or (2) discriminate against individuals for good faith complaints relating to the care, services, or conditions of the hospital or related facilities. HHS may impose civil monetary penalties on hospitals violating the ratio requirements and must publish the names of such hospitals.

The bill provides stipends to the nurse workforce loan repayment and scholarship program and expands the nurse retention grant program to include nurse preceptorship and mentorship projects.

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.

Resident Physician Shortage Reduction Act of 2025

This bill increases the number of residency positions eligible for graduate medical education payments under Medicare for qualifying hospitals, including hospitals in rural areas and health professional shortage areas.

The bill provides for an additional increase of 2,000 positions per fiscal year from FY2026-FY2032; during this period, each hospital may receive up to 75 additional positions in total under the bill and current law. Additionally, one-third of the positions that are made available under the bill must be allocated to hospitals that are already operating above applicable resident limits.

The bill also requires the Government Accountability Office to report on strategies to increase the diversity of the health professional workforce, including with respect to representation from rural, low-income, and minority communities.