The bill amends section 1804 of the Social Security Act to require the Secretary of Health and Human Services to run outreach and education telling Medicare beneficiaries that they can authorize a family caregiver to access their personal health information through the existing 1‑800‑MEDICARE telephone line if the beneficiary completes a specified authorization form. The outreach must put the authorization form in prominent, accessible places (including the statutorily required notice, Medicare.gov, and activities targeted at Medicare Advantage enrollees), train 1‑800‑MEDICARE operators, offer the materials in non‑English languages, and coordinate with State Health Insurance Assistance Programs (SHIPs) and the Administration for Community Living.
The bill also directs the HHS Office of Inspector General to publish best practices within one year to reduce fraud and improve timeliness of agency investigations, and it requires CMS to solicit caregiver feedback (for example, via surveys). For compliance officers and operational leaders, the bill creates a new, centralized access channel and a set of programmatic duties for CMS that will require changes to call‑center procedures, multilingual materials, and interagency coordination — all without changing Medicare benefit entitlements.
At a Glance
What It Does
Adds a new subsection to 42 U.S.C. 1395b–2 directing the Secretary to provide outreach and education about an option that lets beneficiaries authorize family caregivers to access the beneficiary’s personal health information through the toll‑free 1‑800‑MEDICARE line, conditional on a completed authorization form. It requires inclusion of the authorization form in key consumer touchpoints, operator training, multilingual materials, OIG best practices, and caregiver feedback mechanisms.
Who It Affects
Directly affects CMS operations (particularly the 1‑800‑MEDICARE call center), Medicare beneficiaries and family caregivers, Medicare Advantage plans (which must be reached by CMS outreach), SHIPs and the Administration for Community Living (for coordination), and providers/suppliers who interact with beneficiaries and caregivers.
Why It Matters
It creates a single, government‑run pathway for caregivers to get information by phone — standardizing an access route that has been uneven in practice — while pairing that access with mandated fraud‑prevention guidance and operator training. For program managers this shifts workload to CMS call centers and creates a likely spike in authentication, documentation, and fraud‑reporting tasks.
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What This Bill Actually Does
The bill builds an administrative pathway for family caregivers to get beneficiary information by phone rather than by litigation or ad hoc arrangements. A beneficiary who wants a trusted person to ask about coverage, claims, or benefit details will complete the designated caregiver authorization form and then a named caregiver can call 1‑800‑MEDICARE and, under protocols CMS develops, obtain the allowed personal health information.
The Secretary must make the option obvious: include the form in required notices, on Medicare.gov, and in outreach targeted to Medicare Advantage enrollees; the agency must also make the materials prominent, easily accessible, and understandable.
Recognizing fraud risk, the bill assigns the HHS Office of Inspector General to produce and publish best practices within one year for protecting beneficiaries against inappropriate access or misuse. That guidance must address separate audiences (beneficiaries, caregivers, providers, and other entities) and include recommendations to speed agency investigations of reported fraud.
CMS must train 1‑800‑MEDICARE operators to guide family caregivers appropriately and to surface suspected fraud through existing reporting channels.Operationally, the statute requires CMS to produce multilingual materials as the agency specifies, to coordinate outreach with SHIPs and the Administration for Community Living where practicable, and to collect caregiver feedback via mechanisms such as surveys. The bill ties the access option to an existing CMS form rather than creating a novel legal right to records; it therefore sets procedural guardrails for phone‑based access while leaving substantive privacy law (for example, HIPAA and applicable state rules) intact and requiring CMS to reconcile its procedures with those laws.
The Five Things You Need to Know
The bill inserts a new subsection (e) into section 1804 of the Social Security Act to establish the outreach and education duties.
It designates the caregiver authorization document as the CMS–10106 form (or a successor), making that specific form the statutory trigger for caregiver phone access.
The HHS Office of Inspector General must publish publicly available best practices to combat fraud and recommend improvements to agency investigation timelines within 1 year of enactment.
CMS must train 1‑800‑MEDICARE operators to provide appropriate resources to family caregivers and to recognize and report suspected fraud.
All outreach materials and the authorization form must be provided in non‑English languages as determined by the Secretary, and CMS must, to the greatest extent practicable, coordinate with SHIP programs and the Administration for Community Living.
Section-by-Section Breakdown
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Short title
Names the legislation the “Connecting Caregivers to Medicare Act of 2025.” This is procedural and carries no operational effect, but it signals the bill’s focus on caregiver access and frames CMS’s subsequent responsibilities under section 1804.
Core outreach mandate and eligibility trigger
Paragraph (1) requires the Secretary to provide outreach and education informing individuals entitled to benefits under Part A or enrolled under Part B — and applicants — about the option to authorize a family caregiver to access their personal health information by phone. The access is conditional on the beneficiary completing and submitting the specified family caregiver information access authorization form; that form is the gatekeeper that CMS must accept and publicize.
Where and how to present the option
Paragraph (2) lists required channels and presentation standards: the authorization option and form must be prominent in the notice under subsection (a), on Medicare.gov, in outreach targeted at Medicare Advantage enrollees, and through other Secretary‑specified platforms (for example, social media). Paragraph (2) also directs CMS to train 1‑800‑MEDICARE operators and to distribute best practices for fraud protection to multiple audiences.
OIG report on fraud and investigative timeliness
Paragraph (4) tasks the HHS OIG with producing publicly available best practices within one year to protect beneficiaries against fraud relating to inappropriate access or use of personal health information, and to recommend improvements for agency investigation timeliness. Crucially, OIG guidance must include separate best‑practice sets tailored to beneficiaries, caregivers, providers, and other entities — which raises the possibility of multiple implementation tracks for training and outreach.
Clarifications, feedback, language access, coordination, and definitions
Paragraph (3) requires outreach materials to clarify that the caregiver option applies whether the beneficiary is in fee‑for‑service or a Medicare Advantage plan. Paragraph (5) obliges CMS to solicit caregiver feedback (for example via surveys). Paragraph (6) requires non‑English materials as specified by the Secretary. Paragraph (7) calls for coordination, to the greatest extent practicable, with SHIP programs and the Administration for Community Living. Paragraph (8) imports the statutory definition of “family caregiver” from the RAISE Family Caregivers Act and names CMS–10106 as the specified form.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Family caregivers who need quick access to coverage and claims information — they gain a clear, government‑run phone route to get beneficiary information after the beneficiary completes the authorization form, shortening the time to resolve routine questions.
- Medicare beneficiaries with complex care situations — by enabling an authorized caregiver to act as an information conduit, beneficiaries can reduce administrative burden and improve care coordination without resorting to ad hoc workarounds.
- State Health Insurance Assistance Programs and community organizations — coordination with CMS and access to standardized materials makes their counseling work more consistent and reduces variability across jurisdictions.
- Call‑center staff and supervisors — while it increases workload, the statute’s training requirement supplies them with standardized protocols and resources that simplify handling caregiver calls once implemented.
Who Bears the Cost
- CMS — will need to update notices, website content, forms, call‑center scripts, staffing models, training curricula, translation efforts, and tracking systems with no appropriations language in the bill.
- 1‑800‑MEDICARE operations — must develop authentication processes, train operators, and handle potentially higher call volumes and fraud reports, which may require additional staffing or reprioritization of existing resources.
- Medicare Advantage plans and providers — although not required to change benefits, they must be included in outreach efforts and may see more caregiver inquiries routed through CMS, adding coordination costs.
- State SHIP programs and ACL partners — expected coordination and possible participation in outreach and training will consume staff time and resources, particularly for smaller programs with limited capacity.
- Fraud‑investigation units at CMS and OIG — the bill anticipates increased reporting and asks for timelier investigations, which could pressure investigative caseloads and require reallocating resources.
Key Issues
The Core Tension
The central dilemma is between streamlining caregiver access to improve beneficiary care coordination and protecting beneficiary privacy and financial security: lowering friction helps families get timely information, but every step that makes access easier increases the risk of improper disclosure or fraud, and the bill gives CMS discretion to pick where on that spectrum it lands.
The bill creates an administrative access channel but stops short of defining the precise scope of “personal health information” a caregiver may obtain by phone. That gap forces CMS to reconcile the new pathway with HIPAA and state privacy laws when it crafts operational procedures; the statute’s silence about permissible data elements (claims status only, clinical details, or billing information) is an implementation choke point.
Telephone authentication is another unresolved technical question: the bill requires operator training but leaves the authentication methods, evidence required from caregivers, and retention of authorization records to CMS discretion.
Resourcing is the other practical snag. The statute imposes multiple new duties on CMS, OIG, SHIPs, and call centers but contains no appropriations or express funding mechanism.
Expect tradeoffs: meeting one‑year OIG timelines, providing meaningful multilingual coverage, and improving investigative timeliness will each demand staff time and systems investment. Finally, the bill’s fraud‑prevention language creates an unavoidable tension between ease of access for caregivers and barriers designed to prevent misuse — too strict authentication defeats the purpose; too lax invites fraud.
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