Bipartisan Health Care Act

Streamlined Medical Care for Young People: Eligible out-of-state providers can enroll more easily to provide items and services to qualifying individuals under 21, which could increase access to care (Sec. 101).

Increased Transparency for Home Services: States will be required to provide more detailed information regarding waiting lists and the time it takes for individuals to receive home or community-sited services (Sec. 102).

Expansion of Home-Based Care: A new demonstration program would allow up to five States to expand coverage for home or community-based services (Sec. 102).

Better Support for Military Families: Active duty relocated individuals will be treated as residents of their new State for Medicaid eligibility, helping them maintain continuity of care (Sec. 104).

Improved Access via Telehealth: The bill extends various telehealth flexibilities, including audio-only services and expanded access for rural health clinics and Federally Qualified Health Centers (Sec. 209). Telehealth services also benefit from an extended safe harbor allowing high deductible health plans to not require a deductible for remote care (Section 1001).

Expanded Diabetes Prevention: The bill allows for the inclusion of virtual diabetes prevention program suppliers in the Medicare Diabetes Prevention Program Expanded Model (Sec. 215).

Enhanced Medicare Coverage: The bill includes provisions for Medicare coverage of multi-cancer early detection screening tests and coverage for external infusion pumps and certain home infusion drugs (Sec. 224, 225).

Improved Medicare Part D Costs: The bill adjusts cost-sharing reductions for low-income individuals, which could lead to lower copayments for generic and preferred drugs for plan years starting in 2027 (Section 222).

Enhanced Provider Directory Accuracy: Medicare Advantage organizations will be required to maintain more accurate provider directories, helping enrollees find correct information for their care (Section 223).

Financial Protections for Misinformation: If an enrollee relies on an incorrect provider directory, the bill ensures they are only responsible for the lesser of the in-network or out-of-network cost-sharing amount (Section 223).

Increased Pharmacy Choice and Fairness: The bill requires prescription drug plans to permit any willing pharmacy to participate and establishes standards to ensure contract terms are reasonable and relevant (Section 226).

Expanded Health Services: Funding is extended for community health centers, the National Health Service Corps, and teaching health centers to maintain service availability (Section 401).

Specialized Healthcare Support: The bill provides support and resources for individuals and families impacted by Fetal Alcohol Spectrum Disorders (Section 399H).

Enhanced Suicide Prevention Security: Steps are taken to protect the National Suicide Prevention Lifeline from cybersecurity incidents to ensure the service remains reliable (Section 518).

Drug Safety and Disposal: The Secretary of Health and Human Services will publish guidance to make at-home drug disposal easier and more effective (Sec. 520).

Opioid Safety Assessment: The FDA is required to create a plan to assess the safety and public health effects of approved opioid drugs (Sec. 521).

Overdose Prevention: Funding may be used to help people access products like fentanyl and xylazine test strips to prevent overdose deaths (Sec. 522).

Support for Mothers: The bill increases funding for residential treatment programs specifically designed for pregnant and postpartum women (Sec. 531).

Workforce Development: There is an increase in funding for loan repayment programs to help build the substance use disorder treatment workforce (Sec. 534).

Mental Health Support: Funding is extended for mental and behavioral health education and training (Sec. 533).

Community Recovery: Funding is increased to help build communities of recovery (Sec. 541).

Pandemic Readiness: The bill increases funding for the Public Health Emergency Preparedness Program to help entities respond to all-hazards threats (Sec. 612).

Disease Detection: A new program is established to fund wastewater surveillance to detect and monitor infectious diseases (Sec. 616).

Maternal Health Research: The bill funds a study through the National Academies to understand the causes of premature births and how to improve outcomes (Section s. 702).

Sickle Cell Care: Funding is increased for the treatment of sickle cell disease and the prevention of its complications (Section 704).

Improved Traumatic Brain Injury Oversight: The bill expands the definition of traumatic brain injury and enhances surveillance to identify high-risk populations and the causes of these injuries (Section 393C).

Increased Research for Down Syndrome: The creation of the INCLUDE Project will fund research into the effects of trisomy 21 on human development, co-occurring conditions, and the improvement of quality of life (Section 409K).

Maternal Health Improvements: The IMPROVE Initiative aims to reduce preventable maternal mortality and morbidity through research and community-based interventions (Section 409L).

Enhanced Pediatric Cancer Treatment: The bill authorizes molecularly targeted investigations for pediatric cancer drugs to improve dosing, safety, and efficacy for children (Section 505B).

Increased Prescription Drug Transparency: Pharmacy benefit managers will be required to submit detailed reports to group health plans regarding drug costs, compensation, and spending, which aims to lower prescription drug costs (Section 901).

Support for Organ Donation: The legislation clarifies that the income of an organ recipient shall not be considered when providing reimbursement to a donating individual (Section 712).

Increased Transparency in Pharmacy Costs: The bill requires pharmacy benefit managers to provide detailed information about drug costs, including amounts charged to plans versus participants and comparisons to non-affiliated pharmacies (Section 2-A-iv-III). This helps people and their employers understand exactly what they are paying for.

Access to Information: Group health plans must provide summary documents to participants and beneficiaries upon request, allowing them to better understand their specific benefits (Section 2-B-ii).

Full Rebate Pass-Through: The law requires that 100 percent of rebates, fees, and discounts related to drug spending be remitted to the group health plan (Section 902-a-C-i-aa). This ensures that the financial benefits of drug rebates are shared with the plan rather than being kept by the middleman.

Clarity in Generic Drug Applications: The Secretary of Health and Human Services will now inform applicants whether a drug is qualitatively and quantitatively the same as a listed drug, providing specific details if there is a deviation (Section s. 903-a). This can streamline the process for bringing generic drugs to market.

Increased Oversight for Pharmacies: Retail and non-retail pharmacies will be subject to new monthly survey requirements regarding drug acquisition costs and may face civil money penalties for non-compliance (Sec. 112).

Increased Program Integrity Checks: The bill introduces new requirements for the Secretary to conduct checks on the Death Master File to identify deceased providers and enrollees, which could lead to disenrollment (Sec. s 106, 107).

New Requirements for Medical Equipment: The bill introduces new "aberrant billing pattern" recognitions for certain durable medical equipment, which may lead to more prepayment reviews of claims (Sec. 212).

Increased Costs for Some Drugs: For plan years starting in 2027, while generic drugs may see reductions, copayments for "any other drug" may be adjusted based on the consumer price index (Section 222).

Medicare Payment Reductions: The bill includes a provision for a 2.0 percent payment reduction for certain Medicare programs during the first two months of fiscal year 2033 (Section 229).

Administrative Burdens for Providers: Medicare Advantage organizations and providers must comply with new, stricter requirements for maintaining and verifying provider directory accuracy (Section 223).

Drug Screening Age Limitations: Coverage for multi-cancer early detection screening tests is subject to specific age limitations, such as being at least 50 years of age (Section 224).

Research Limitations on Pathogens: There are restrictions on funding research that involves the creation or use of enhanced pathogens if the research is conducted by certain foreign entities, such as the People's Republic of China or the Russian Federation (Sec. 629A).

Research Competition: The bill includes a study to look at whether replacing drug patents with innovation prizes would change the number of drugs developed or the rate at which they are brought to market (Sec. 634).

Potential Burdens on Pediatric Drug Development: The FDA's new requirements for molecularly targeted pediatric cancer investigations may include burdens on drug development (Section 505B).

Administrative and Financial Obligations for Pharmacy Entities: Pharmacy benefit management entities must comply with new, highly detailed reporting requirements or face civil monetary penalties of up to $10,000 per day (Section 901).

New Fees for Organ Transplantation: The Secretary is authorized to collect registration fees from members of the Organ Procurement and Transplantation Network for each transplant candidate placed on a list (Section 372).

Increased Litigation Complexity: While the bill attempts to limit patent assertions, it still allows a reference product sponsor to assert up to 20 patents, and a court can increase that number for "good cause" (Section 904-a). This could still result in complex legal battles for those bringing new biological products to market.

Privacy and Data Handling: Because the bill involves the collection and reporting of detailed pharmacy and health information, it places a heavy emphasis on strict adherence to privacy regulations to prevent the misuse of personal health data (Section 2-4).