William Keating

Clinical Trial Modernization Act

This bill authorizes a grant program and provides certain exemptions to support the participation of individuals in clinical trials.

Specifically, the bill authorizes a grant program to support outreach, education, and recruitment efforts for clinical trials that may benefit certain underrepresented populations or communities in need, such as rural or tribal areas.

The bill also exempts from anti-kickback laws for federal health care programs (1) remuneration that is offered to cover participants' expenses to participate in clinical trials, (2) the provision of free digital health technologies to support participation of underrepresented populations in clinical trials, and (3) payment for participants' cost-sharing obligations in relation to clinical trials.

Finally, the bill exempts up to $2,000 in remuneration that is received for participating in a clinical trial from income tax.

No Tax Breaks for Union Busting (NTBUB) Act

This bill excludes from the tax deduction for ordinary and necessary business expenses amounts paid or incurred to influence employees with respect to labor organizations or labor organization activities. The bill also imposes information reporting requirements related to such expenses and imposes penalties for failure to comply.

Under the bill, amounts paid to influence employees with respect to labor organizations include amounts paid (including wages and other costs)

• in connection with an action that results in a complaint or settlement related to an unfair labor practice or a finding of interference, influence, or coercion related to railway employees’ rights to organize and bargain collectively;

• for any meeting or training attended by employees and at which labor organizations are discussed; and

• that require certain employer disclosures and financial reporting.

(Some exceptions apply.)

The bill requires employers to file a return reporting certain information related to expenses paid to influence employees with respect to labor organizations and imposes a penalty for noncompliance. The amount of the penalty is the greater of (1) $10,000, or (2) $1,000 multiplied by the number full-time equivalent employees. Additional penalties apply for violations that continue for more than 90 days.

The bill also imposes information reporting requirements on persons conducting activities on behalf of another person to influence employees with respect to labor organizations.

The bill allows certain penalties for noncompliance with the reporting requirements to be waived if noncompliance is due to reasonable cause and not willful neglect.

Goldie's Act

This bill expands enforcement provisions under the Animal Welfare Act (AWA).

Specifically, the bill directs the Department of Agriculture (USDA) to document and record detailed descriptions of violations of the act observed during inspections and investigations. USDA must provide a copy of all records documenting violations to state, local, and municipal animal control or law enforcement officials within 24 hours of such inspections or investigations.

Inspections must be held at least once a year of each research facility, the premises of each animal dealer, and each exhibitor of animals. If violations are found during inspections, then USDA must conduct any necessary follow-up inspections until all the violations are corrected. Inspectors must confiscate or destroy in a humane manner animals found to be suffering physical or psychological harm as a result of failure to comply with the AWA.

Violators are subject to civil penalties as outlined in the bill.

Patients First Act of 2026

This bill modifies payments and incentive programs under the Medicare physician fee schedule.

The bill establishes a temporary program to provide hybrid payments for certain primary care services. Under the program, payments for services relating to care management, behavioral health integration, office-based evaluation and management (including telehealth), and communications (e.g., phone calls) are made on a monthly basis to providers for each individual that is attributed to the provider's practice. The monthly amount is based on the national average amount for such services. Providers may opt into the model; in order to qualify, providers must be owned or controlled by health care practitioners and must have had the majority of their prior year's payments consist of payments for the covered services.

The bill also renames the Merit-based Incentive Payment System (MIPS) and modifies the program to include performance measures relating to care efficiency (e.g., reducing avoidable hospitalizations). (MIPS is an incentive program under Medicare that allows health professionals to receive payment adjustments based on certain performance measures.) The bill generally reduces the program's performance-based payment adjustments, including positive adjustments for providers that are not owned or controlled by health care practitioners.

Finally, the bill allows for larger annual adjustments to the Medicare physician fee schedule and bases these adjustments on inflation. It also requires 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.