Michael Rulli

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.

Medicare Audiology Access Improvement Act of 2025

This bill provides for Medicare coverage of certain audiology services. Specifically, the bill expands coverage to include diagnostic and treatment services that are furnished by audiologists and that would otherwise be covered if provided by a physician, including incidental services, regardless of whether such services are provided pursuant to a referral from, or under the supervision of, a physician or other health care practitioner.

Restore Protections for Dialysis Patients Act

This bill specifies certain requirements for private health insurers regarding coverage of individuals with end stage renal disease (ESRD) who are also covered under Medicare.

In particular, the bill specifies that insurers may not limit benefits, including limiting network composition, in a manner that will affect ESRD Medicare beneficiaries differently compared to others without ESRD. The bill additionally specifies that insurers are not required to include a particular renal dialysis provider or a particular number of such providers as part of their networks.

Essential Caregivers Act of 2025

This bill prohibits certain health care facilities from limiting the access of essential caregivers to residents of those facilities, including during designated emergency periods.

Specifically, the bill generally prohibits Medicare skilled nursing facilities, Medicaid nursing facilities, Medicaid intermediate care facilities, and associated inpatient rehabilitation facilities from restricting the access of essential caregivers to residents of the facilities, including during emergency periods in which visitation rights are otherwise restricted. During emergency periods, facilities may restrict access for an initial period of up to seven days and for one additional maximum seven-day period (if the additional period is approved by the state health department). Facilities may restrict access for a total of 7 days (or 14 days with the approval of the state health department) during an emergency period.

Essential caregivers must agree to comply with any safety protocols set by the facility, which may be no more stringent for caregivers compared to those for staff. Caregivers who fail to comply with these requirements may be denied access, subject to an appeals process.

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.

Building Unrivaled Infrastructure and Long-term Development for America's 250th Act or the BUILD America 250 Act

This bill authorizes federal surface transportation (highway, public transportation, and rail) programs and activities through FY2031. The bill also establishes or modifies Department of Transportation (DOT) programs and policies that are a part of the federal-aid highway, transit, highway safety, motor carrier, research, hazardous materials, and rail programs.

For example, the bill authorizes appropriations through FY2031 out of the Highway Trust Fund for the federal-aid highway program, the Transportation Infrastructure Finance and Innovation Act (TIFIA) program, highway safety programs, and bridge programs. The bill also authorizes funding through FY2031 for Amtrak. Current authorization for these programs expires on September 30, 2026.

Among other provisions, the bill

• establishes a Surface Transportation Accelerator Grant (STAG) discretionary program to fund surface transportation projects in rural, urban, local, and regional communities;

• requires the Federal Highway Administration to impose a new annual electric vehicle (EV) registration fee, starting at $130 for a covered EV and $35 for a covered plug-in hybrid vehicle;

• exempts automated driving system technology and equipment from vehicle width requirements;

• establishes a consolidated state block grant program that allows DOT to allocate a lump sum to participating states to fund public transportation services in rural and urbanized areas;

• allows state rail safety inspectors to conduct railroad bridge inspections; and

• establishes a system for state, local, and tribal governments to report safety concerns about the condition of railroad bridges.

Title IX Clarification Act of 2026

This bill defines the terms sex, female, and male for purposes of Title IX of the Education Amendments of 1972. Title IX prohibits discrimination on the basis of sex in education programs that receive federal financial assistance.

Specifically, the bill defines sex as an individual’s biologically determined sex, as either male or female. Therefore, Title IX's prohibition on sex discrimination only applies to biological sex under the bill.

The bill defines female, when used with respect to a natural person, as an individual who naturally has, had, will have, or would have, but for a congenital anomaly, historical accident, or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes the large gamete (ova) for fertilization.

The bill defines male, when used with respect to a natural person, as an individual who naturally has, had, will have, or would have, but for a congenital anomaly, historical accident, or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes the small gamete (sperm) for fertilization.

(A January 20, 2025, executive order stated that it is the policy of the United States to recognize two sexes—male and female—which are not changeable. On February 4, 2025, the Department of Education announced its intent to enforce its Title IX regulations consistent with this executive order. For more information on the status of these regulations, see LBS11279.)

This concurrent resolution expresses support for law enforcement officers. It also appreciates the contributions and recognizes the sacrifices of law enforcement officers.

This resolution honors the contributions of small businesses in the United States and supports the designation of National Small Business Week.