“The bills the Committee will consider this Thursday are solutions that bring Medicare coverage policies out of the past and into the Twenty First Century.”

WASHINGTON, D.C. –  The Ways and Means Committee will hold a markup on Thursday, June 27, 2024 to consider legislation that will promote medical innovation and improve care by streamlining coverage pathways of new drugs and medical devices under Medicare, as well as legislation to remove barriers to treatment and increase access to new medical tests and screenings for seniors.

Ways and Means Committee Chairman Jason Smith (MO-08) said, “The Ways and Means Committee has held hearings both here in Washington and across the country to hear from patients and medical providers about how Congress can advance solutions to ensure patients have access to the best care that fits their needs. As Chairman, I have heard firsthand from doctors, hospitals, and medical experts how streamlining Medicare coverage of lifesaving treatments, as well as increasing patient access to new and innovative diagnostic screenings will lead to earlier diagnosis, lower costs, and better patient outcomes.”

“For too long, Medicare patients have been forced to navigate complex and arbitrary rules that limit their access to care. The bills the Committee will consider this Thursday are solutions that bring Medicare coverage policies out of the past and into the Twenty First Century.”

Legislation Under Consideration:

H.R. 2407, Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act

• Provides transitional Medicare coverage and reimbursement for FDA-approved multi-cancer early detection screening tests for a first group of beneficiaries most impacted by early screening until a traditional coverage decision is issued with coverage expanded to all.
• Newly eligible Medicare beneficiaries, and those becoming eligible within the next few years, will receive access to covered multi-cancer screening tests, with those individuals continuing to receive coverage in perpetuity.
• This policy ensures timely coverage of innovative cancer screening tests so at-risk Medicare patients can receive the care and treatment needed to live healthier lives.

H.R. 8816, American Medical Innovation and Investment Act

• Prohibits CEDs from lasting longer than 10 years unless agreed upon by the applicant, guarantees a determination whether a request for a NCD is complete within 90 days, and prohibits LCDs from being more restrictive than existing NCDs.
• Requires Medicare to clarify and update coverage for AI-enabled dosing devices and PDTs. 
• Guarantees coverage of self-administered home infusion pumps.
• Provides a budget-neutral pilot program for medically tailored meals for seniors.
• Requires cognitive impairment tests for Alzheimer’s to be conducted with up-to-date devices. 

H.R. 1691, Ensuring Patient Access to Critical Breakthrough Products Act

• Provides a distinct pathway for immediate four years of transitional Medicare coverage of breakthrough medical devices – mirroring the Trump Administration final rule and requires the Centers for Medicare and Medicaid Services (CMS) to make a permanent coverage determination by the end of the coverage period. 
• This expedited coverage pathway will encourage more innovative medical devices to come to market and provide Medicare patients with needed treatments and cures quicker.

H.R. 4818, Treat and Reduce Obesity Act

• Provides Medicare Part D coverage of AOMs to individuals aging into Medicare who are currently being treated by an AOM, ensuring they do not lose coverage for their effective therapies.
• Without this coverage, 1.25 million patients are projected to lose coverage over the next decade as they transition into Medicare, driving up long term health costs.
• Requires Medicare to re-evaluate its coverage of “Intensive Behavioral Therapy” (IBT) so that seniors can be effectively treated through diet and exercise.
• Requires MedPAC to report on the coverage of AOMs in pre-Medicare markets and how use among those populations may affect usage by enrollees to lay the groundwork for expanded coverage to more individuals.

READ: Five Key Moments from Health Subcommittee Hearing on Medical Innovation and Access to Care