Bipartisan Health Care Act

Summary#

This bill, titled the Bipartisan Health Care Act, would extend many expiring Medicare, Medicaid, and public health program provisions and add new rules on health care delivery. Major areas covered include Medicaid changes (streamlined out-of-state provider enrollment for certain pediatric care, more reporting and transparency for home and community-based services, changes to optional eligibility for working adults with disabilities, residency rules for military families, and requirements to check death records to remove deceased providers and enrollees). It also creates a 5-State demonstration to expand home and community-based services and funds planning grants.

The bill makes many Medicare changes, such as extending payment adjustments for low-volume and Medicare-dependent hospitals, extending telehealth flexibilities and some telehealth payment rules, extending certain temporary payment increases and quality program funding, expanding coverage rules (for example, creating a process to cover certain multi-cancer early detection screening tests and adding external infusion pumps and non-self-administered home infusion drugs), and extending or modifying other payment and program authorities. It adds reporting, audit, and integrity rules for durable medical equipment and laboratory testing.

The bill also addresses prescription drug payment and market practices. It requires national surveys of pharmacy acquisition costs, reporting and penalties for noncompliance, limits abusive spread pricing in Medicaid, and creates new transparency, reporting, and accountability requirements for pharmacy benefit managers (PBMs) and for Medicare Part D and PDP sponsors. It includes numerous requirements for pharmacy reporting to plans and for plan disclosures to enrollees.

Other provisions extend and fund many public health, behavioral health, and preparedness programs (community health centers, National Health Service Corps, opioid and recovery programs, pandemic preparedness, wastewater surveillance, regional biocontainment labs, mosquito abatement, and more). The bill also includes studies and reports (for example, on wearable medical devices, costs of maternity services, and GAO studies on PBM arrangements). It makes many technical and statutory edits across health programs and includes many specific appropriations and deadlines.

What it means for you#

• If you use Medicaid or CHIP and are under 21, the bill would let certain out-of-state providers enroll more easily in some states and adds new state reporting on home and community-based services waitlists and service start times.
• If you are a Medicare beneficiary, the bill would extend some telehealth rules, change some payment adjustments for hospitals and providers, and create a path for national coverage decisions for certain multi-cancer early detection tests beginning in 2029 (with age and frequency limits described in the bill).
• If you work in pharmacies or as pharmacy benefit managers, the bill would require more frequent reporting of prices, audits, and, for PBMs, detailed annual reporting to plans and the Secretary. States and plans would have new contract and transparency requirements.
• If you are a hospital or health care provider, the bill includes extensions or changes to hospital payments, programs for acute care at home, reporting requirements, and adjustments to disproportionate share hospital allotments.
• Public health and emergency preparedness programs named in the bill would receive extensions or additional funding and new reporting or planning duties.

Expenses#

The bill includes many specific appropriations and funding directions throughout the text. Examples from the bill include:

• $71,000,000 for fiscal year 2025 to support HCBS guidance and a demonstration program, with $50,000,000 reserved for planning grants (Sec. 102).
• $1,000,000 per year for fiscal years 2025–2029 to implement certain Medicaid residency rules for military families (Sec. 104).
• $10,000,000 for fiscal year 2025 to help small hospitals compile cost information for maternity service studies, plus $3,000,000 for implementation of that section (Sec. 109).
• Multiple appropriations for Medicare and program management: for example, $188,000,000 for certain pharmacy access work in fiscal year 2025 (Sec. 226), $113,000,000 for CMS to implement PBM rules plus $20,000,000 for HHS OIG (Sec. 227), and $6,000,000 to study Acute Hospital Care at Home (Sec. 211).
• Many other specified funding amounts and extensions for public health programs, grant programs, and Centers for Disease Control and Prevention activities are listed in the bill text.

Proponents' View#

The bill text and metadata state the purpose: to extend expiring health provisions and improve health care delivery. Sponsors introduced it to continue and update many Medicaid, Medicare, public health, and drug program authorities, add transparency and integrity measures (especially for pharmacies and PBMs), and fund public health and preparedness programs.

Opponents' View#

No publicly available information.