S. 4358 – SAFE through Medicare Act

AI-Generated Summary

Updated April 29, 2026 at 9:47 AM UTC

The SAFE through Medicare Act would expand Medicare to cover medically necessary home resiliency services for beneficiaries who are at risk during climate or man‑made disasters. It adds a new category of services—such as heat pumps, solar batteries, and temperature‑controlled storage—to Medicare for individuals whose health depends on stable home conditions. The law creates a process, involving the NIH, CMS, and NOAA, to identify medically at‑risk individuals based on geography, disaster history, and health needs. Payments for these services would be made at up to 100 % of the cost, limited by a fee schedule.

Key Provisions

Adds a new Medicare benefit for "home resiliency services" for individuals deemed medically at‑risk in climate or man‑made disasters.
Defines home resiliency services to include items like heat pumps, solar batteries, and cold‑storage for temperature‑sensitive medical supplies.
Requires the Secretary, in consultation with NIH, CMS, and NOAA, to establish a process for determining which individuals are medically at‑risk, considering regional climate risks, disaster history, equipment reliance, and chronic conditions.
Amends payment rules so Medicare will pay 100 % of the lesser of the actual charge or a fee‑schedule amount for these home resiliency services.

Legislative Activity

Stay on top of the latest movement without scrolling through every action

1 earlier action

SenateIntro Referral Latest Action

Read twice and referred to the Committee on Finance.

Finance Committee

April 21, 2026

View full timeline

SenateIntro Referral

Introduced in Senate

April 21, 2026

SenateIntro Referral

Read twice and referred to the Committee on Finance.

Finance Committee

April 21, 2026

Bill Text

Latest available legislative text

Reading Mode

Raw Text PDF XML

Introduced in SenateIssued April 21, 2026

II

119th CONGRESS

2d Session

S. 4358

IN THE SENATE OF THE UNITED STATES

April 21, 2026

Mr. Markey introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to provide coverage of medically necessary home resiliency services under Medicare.

1.

Short title

This Act may be cited as the Survival Aid For Emergencies through Medicare Act or the SAFE through Medicare Act.

2.

Medicare coverage of medically necessary home resiliency services

(a)

Coverage

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—

(1)

in subsection (s)(2)—

(A)

in subparagraph (JJ), by striking and at the end;

(B)

in subparagraph (KK), by inserting and at the end; and

(C)

by adding at the end the following new subparagraph:

(LL)

in the case of an individual who is medically at-risk in the event of a climate or manmade disaster (as determined by the Secretary in accordance with subsection (ooo)), home resiliency services (as defined in such subsection);

; and

(2)

by adding at the end the following new subsection:

(ooo)

Home resiliency services; determination of individuals medically at-Risk

(1)

Home resiliency services

The term home resiliency services means items and services—

(A)

furnished on or after January 1, 2027, to an individual described in subsection (s)(2)(LL); and

(B)

that the Secretary determines are medically necessary for such individual in the case of a climate or manmade disaster, such as a heat pump for an individual vulnerable to extreme temperatures, solar batteries for an individual reliant on electrical medical equipment (including home mechanical ventilators), and energy efficient cold-storage for heat-sensitive medical supplies.

(2)

Determination of individuals medically at-risk

For purposes of subsection (s)(2)(LL) and this subsection, the Secretary, in consultation with the Director of the National Institutes of Health, the Administrator of the Centers for Medicare & Medicaid Services, and the Administrator of the National Oceanic and Atmospheric Administration, shall establish a process to determine the conditions under which an individual would be determined to be medically at-risk in the event of a disaster or climate hazards, including extreme heat, extreme cold, flooding, and loss of power. Such a process shall consider—

(A)

geography-specific climate risks and regional preparedness for different climate risks;

(B)

the regional history of disaster or climate hazards and infrastructure failure in the preceding 20 years or the forward-looking predicted risk of disaster or climate hazards and infrastructure failure in the next 20 years;

(C)

medical reliance on equipment, pharmaceuticals, mobility aids, and other supplies that are sensitive to exposure to extreme temperatures, poor air quality, flooding and water damage, or dependent on electrical power; and

(D)

chronic medical conditions, disabilities, and comorbidities that increase patient vulnerability during disaster.

.

(b)

Payment

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—

(1)

by striking and before (HH); and

(2)

by inserting before the semicolon at the end the following: and (II) with respect to home resiliency services described in section 1861(s)(2)(LL), the amount paid shall be an amount equal to 100 percent of the lesser of the actual charge for the services or the amount determined under a fee schedule established by the Secretary.