PAVE Act

Bill Number: H.R. 5736
Origin Chamber: House
Congress: 119th Congress, Session 1
Policy Area: Health
Status: Introduced
Latest Action: 2025-10-10: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Last Updated: 2026-06-23T08:05:42Z

AI-Generated Summary

Purpose

The Penicillin Allergy Verification and Evaluation Act (PAVE Act) aims to improve patient safety and health outcomes under Medicare by requiring healthcare providers to assess and verify reported penicillin allergies during routine preventive visits. This addresses the high rate of false allergy labels, which can lead to unnecessary restrictions on effective antibiotic treatments, increased healthcare costs, and poorer recovery from infections.

Key Provisions

Findings Section: Outlines the historical significance of penicillin's discovery in 1928, the prevalence of self-reported allergies (affecting about 10% of the population and 15% of hospitalized patients), and evidence that over 90% of these labels are inaccurate based on testing. It highlights risks like longer hospital stays, higher infection rates, and increased mortality, while noting cost savings from proper evaluation and endorsement by medical organizations for antibiotic stewardship (efforts to use antibiotics wisely to prevent resistance).
Amendments to Medicare Services:
Adds "penicillin allergy verification and evaluation" as a required element of the Initial Preventive Physical Examination (IPPE), a one-time wellness check for new Medicare enrollees.
Includes the same evaluation in the Annual Wellness Visit, an ongoing personalized prevention plan.
Defines the evaluation as: (A) identifying patients who report a penicillin allergy history; (B) reviewing if the reported reaction truly indicates an allergy (e.g., reevaluating non-allergic symptoms like side effects); (C) educating on the personal and public health harms of unverified allergy labels (e.g., limited treatment options leading to broader antibiotic use and resistance); and (D) referring to an allergy or immunology specialist when needed.
Payment Flexibility: Allows separate billing for these allergy services even if provided on the same day as the IPPE or wellness visit.
Effective Date: Applies to services starting January 1, 2027.

Significant Changes to Existing Law

Amends Section 1861(ww) of the Social Security Act (governing IPPE) by inserting the new allergy evaluation requirement and definition, shifting it from optional to a standard part of preventive care.
Modifies Section 1861(hhh) for Annual Wellness Visits by adding the evaluation as an explicit component.
These changes expand Medicare's preventive services without altering core eligibility or coverage rules, focusing on integration into existing exam frameworks.

Potential Impacts

On Citizens: Medicare beneficiaries, particularly those aged 65 and older (where 97% of allergy labels may be disproven per studies), could benefit from safer, more effective antibiotic prescribing, reduced infection risks, shorter hospital stays, and lower personal healthcare costs. It promotes delabeling false allergies, enabling broader access to first-line treatments.
On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) will need to update guidelines, training, and reimbursement processes to incorporate this service, potentially leading to long-term savings through better antibiotic stewardship and fewer complications.
On International Relations: No direct impact, as the bill is domestic Medicare policy.
Overall, it could reduce national healthcare spending by encouraging cost-effective interventions, as supported by medical research.

Main Stakeholders Affected

Medicare Beneficiaries: Primary beneficiaries, especially seniors with reported allergies, who gain from improved preventive care and treatment options.
Healthcare Providers: Physicians, nurses, and allergists/immunologists involved in Medicare visits, who must now include allergy assessments and potential referrals.
Medicare Program and CMS: Responsible for implementation, oversight, and payments, facing administrative updates but potential efficiency gains.
Public Health and Medical Organizations: Groups like the American Academy of Allergy, Asthma & Immunology benefit from alignment with stewardship goals; pharmaceutical companies may see shifts in antibiotic usage patterns.

Notable Legal, Constitutional, or Political Implications

Legal: Strengthens Medicare's preventive focus under Title XVIII of the Social Security Act without expanding eligibility or mandates, ensuring compliance with existing billing rules via the "rule of construction." It avoids liability issues by emphasizing referrals over direct testing.
Constitutional: No significant concerns; it involves federal spending on health services, which is well-established under Congress's spending power.
Political: Bipartisan sponsorship (introduced by Representatives from both parties) signals broad support for evidence-based public health measures. It advances antibiotic stewardship amid growing concerns over resistance, potentially setting a precedent for integrating specific screenings into preventive care, though implementation may require CMS rulemaking to address provider workload.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Griffith, H. Morgan [R-VA-9]

Cosponsors (9)

Rep. Bera, Ami [D-CA-6], Rep. Miller-Meeks, Mariannette [R-IA-1], Rep. Schrier, Kim [D-WA-8], Rep. DelBene, Suzan K. [D-WA-1], Rep. Onder, Robert F. [R-MO-3], Rep. Auchincloss, Jake [D-MA-4], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Murphy, Gregory F. [R-NC-3], Rep. Bacon, Don [R-NE-2]

Recent Actions

2025-10-10: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
2025-10-10: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
2025-10-10: Introduced in House
2025-10-10: Introduced in House

Bill Versions

Penicillin Allergy Verification and Evaluation Act — issued 2025-10-10 — PDF (5 pages)