Strengthening Innovation in Medicare and Medicaid Act
This bill makes a series of changes to requirements for the Center for Medicare and Medicaid Innovation, including additional testing parameters, procedural steps, and reporting requirements for models.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5741 Introduced in House (IH)]
<DOC>
116th CONGRESS
2d Session
H. R. 5741
To amend title XI of the Social Security Act to clarify parameters for
model testing and add accountability to model expansion under the
Center for Medicare and Medicaid Innovation, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 3, 2020
Ms. Sewell of Alabama (for herself, Mr. Smith of Nebraska, Mr.
Cardenas, Mr. Shimkus, Mr. Wenstrup, and Mr. Schrader) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Ways and Means, and
Rules, 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
_______________________________________________________________________
A BILL
To amend title XI of the Social Security Act to clarify parameters for
model testing and add accountability to model expansion under the
Center for Medicare and Medicaid Innovation, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Strengthening Innovation in Medicare
and Medicaid Act''.
SEC. 2. DEFINING CMI MODEL TESTING PARAMETERS.
(a) Scope and Duration of Models.--Section 1115A(a) of the Social
Security Act (42 U.S.C. 1315a(a)) is amended by adding at the end the
following new paragraph:
``(6) Scope and duration of models tested.--Beginning on or
after the date of the enactment of the Strengthening Innovation
in Medicare and Medicaid Act, for purposes of testing new
payment and service delivery models or expanding payment and
service deliver models under this section, the Secretary shall
limit testing of a model--
``(A) to a period not to exceed 5 years; and
``(B) no more applicable individuals than necessary
to obtain a statistically valid sample.''.
(b) Model Requirement Waivers for Hardship.--Section 1115A(a) of
the Social Security Act (42 U.S.C. 1315a(a)), as amended by subsection
(a), is further amended by adding at the end the following new
paragraph:
``(7) Hardship waivers.--Not later than 60 days after the
date of the enactment of the Strengthening Innovation in
Medicare and Medicaid Act, the Secretary shall develop and
implement a plan to allow providers of services and suppliers
to request a waiver from any requirement of a model if the
Secretary determines that such requirement would result in
undue economic hardship to such provider or supplier or loss of
access to such provider or supplier for vulnerable
populations.''.
(c) Monitoring Impact.--Section 1115A(a) of the Social Security Act
(42 U.S.C. 1315a(a)), as amended by subsections (a) and (b), is further
amended by adding at the end the following new paragraph:
``(8) Monitoring impact.--Not later than 60 days after the
date of the enactment of the Strengthening Innovation in
Medicare and Medicaid Act, the Secretary shall develop and
implement a plan to--
``(A) monitor continuously and on a real-time basis
the effect of a model under subsection (b) on
applicable individuals, and mitigate any adverse
impact, such as inappropriate reductions in care or
reduced access to care;
``(B) assess and track the impact of delivery and
payment models on health disparities, using existing
measures such as the National Quality Forum Healthcare
Disparities and Cultural Competency Measure; and
``(C) mitigate any adverse impact that the
Secretary determines could affect beneficiary
health.''.
SEC. 3. IMPLEMENTATION OF TESTING AND EXPANSION OF MODELS WITH
CONGRESSIONAL INACTION.
Section 1115A(d) of the Social Security Act (42 U.S.C. 1315a(d)) is
amended by adding at the end the following new paragraph:
``(4) Implementation of testing and expansion of models
with congressional inaction.--
``(A) The Secretary shall transmit a proposal for
the testing, expansion, or modification of a model
under subsection (b) or (c), including a proposed
effective date and a summary of the determinations and
certification made under paragraphs (1) through (3) of
subsection (c), if applicable, to the Committee on Ways
and Means and the Committee on Energy and Commerce of
the House of Representatives and to the Committee on
Finance and the Committee on Health, Education, Labor,
and Pensions of the Senate.
``(B) The testing, expansion, or modification of
model proposed in a report submitted under subparagraph
(A) shall be carried out by the Secretary if the
Congress does not, within 45 days of receiving a report
transmitted from the Secretary detailing the proposed
testing or expansion including the proposed effective
date for such testing or expansion and a summary of the
determinations and certification made under paragraphs
(1) through (3), pass a joint resolution disapproving
of the proposed testing or expansion in accordance with
the following procedure:
``(i) The succeeding subparagraphs of this
paragraph are enacted by Congress as an
exercise of the rulemaking power of the Senate
and the House of Representatives, respectively,
and as such they shall be deemed a part of the
rules of each House, respectively, but
applicable only with the respect to the
procedure to be followed in that House in the
case of resolutions described in subparagraph
(B). They shall supersede other rules only to
the extent that they are inconsistent
therewith. They are enacted with full
recognition of the constitutional right of
either House to change the rules (so far as
relating to the procedure of that House) at any
time, in the same manner and to the same extent
as in the case of any ruse of that House.
``(ii) For the purpose of the succeeding
provisions of this subparagraph, ``resolution''
means only a joint resolution, the matter after
the resolving clause of which is as follows:
`That Congress disapproves the model expansion
requested pursuant to section 1115A(c) of the
Social Security Act transmitted by the
Secretary on _____, and such an expansion shall
not proceed.', the blank space therein being
filled with the date on which the Secretary's
message proposing such expansion was delivered.
``(iii) Upon receipt of a report submitted
to Congress under subparagraph (c)(4), each
House shall provide copies of the report to the
chairman and ranking member of the Committee on
Ways and Means and the Committee on Energy and
Commerce of the House of Representatives and to
the Committee on Finance and the Committee on
Health, Education, Labor, and Pensions of the
Senate.
``(iv) A resolution shall be referred to
the Committee on Ways and Means and the
Committee on Energy and Commerce of the House
of Representatives and to the Committee on
Finance and the Committee on Health, Education,
Labor, and Pensions of the Senate.
``(v) If a committee to which has been
referred a resolution has not reported it
before the expiration of 10 legislative days
after its introduction, it shall then (but not
before) be in order to move to discharge the
committee from further consideration of that
resolution, or to discharge the committee from
further consideration of any other resolution
with respect to the proposed expansion which
has been referred to the committee. The motion
to discharge may be made only by a person
favoring the resolution, shall be highly
privileged (except that it may not be made
after the committee has reported a resolution
with respect to the same proposed expansion),
and debate thereon shall be limited to not more
than 1 hour, to be divided equally between
those favoring and those opposing the
resolution. An amendment to the motion is not
in order, and it is not in order to move to
reconsider the vote by which the motion is
agreed to or disagreed to. If the motion to
discharge is agreed to or disagreed to, the
motion may not be renewed, nor may another
motion to discharge the committee be made with
respect to any other resolution with respect to
the same proposed expansion.
``(vi) When the committee has reported, or
has been discharged from further consideration
of a resolution, it is at any time thereafter
in order (even though a previous motion to the
same effect has been disagreed to) to move to
proceed to the consideration of the resolution.
The motion is highly privileged and is not
debatable. An amendment to the motion is not in
order, and it is not in order to move to
reconsider the vote by which the motion is
agreed to or disagreed to. Debate on the
resolution shall be limited to not more than 2
hours, which shall be divided equally between
those favoring and those opposing the
resolution. A motion further to limit debate is
not debatable. An amendment to, or motion to
recommit, the resolution is not in order, and
it is not in order to move to reconsider the
vote by which the resolution is agreed to or
disagreed to.
``(vii) Motions to postpone, made with
respect to the discharge from committee, or the
consideration of, a resolution and motions to
proceed to the consideration of other business
shall be decided without debate. Appeals from
the decision of the Chair relating to the
application of the rules of the Senate or the
House of Representatives, as the case may be,
to the procedure relating to a resolution shall
be decided without debate.
``(viii) Coordination with action by other
house.--If, before the passage by one House of
a joint resolution of that House, that House
receives from the other House a joint
resolution, then the following procedures shall
apply:
``(I) The joint resolution of the
other House shall not be referred to a
committee.
``(II) With respect to a joint
resolution of the House receiving the
resolution, the procedure in that House
shall be the same as if no joint
resolution had been received from the
other House, the vote on passage shall
be on the joint resolution of the other
House.
``(ix) If one House fails to introduce or
consider a joint resolution under this section,
the joint resolution of the other House shall
be entitled to expedited floor procedures under
this section.
``(x) If, following passage of the joint
resolution in the Senate, the Senate then
receives the companion measure from the House
of Representatives, the companion measure shall
not be debatable.
``(xi) If Congress passes a joint
resolution, the period beginning on the date
the President is presented with the joint
resolution and ending on the date the President
takes action with respect to the joint
resolution shall be disregarded in computing
the 45-calendar day period described in
subparagraph (c)(4).
``(xii) If the President vetoes the joint
resolution--
``(I) the period beginning on the
date the President vetoes the joint
resolution and ending on the date the
Congress receives the veto message with
respect to the joint resolution shall
be disregarded in computing the 45-
calendar day period described in
subparagraph (c)(4), and
``(II) debate on a veto message in
the Senate under this section shall be
1 hour equally divided between the
majority and minority leaders or their
designees.''.
SEC. 4. PUBLIC INPUT AND CONSULTATION.
Section 1115A(d) of the Social Security Act (42 U.S.C. 1315a(d)),
as amended by section 3, is further amended by adding at the end of the
following new paragraphs:
``(6) Public input.--The Secretary shall use a process
involving advance public notice and an opportunity for
stakeholder input and public comments to ensure transparency
and accountability regarding the establishment, testing,
implementation, evaluation, and expansion of a model under
subsections (b) and (c) of section 1115A. Such public notice
shall describe and define the standards, criteria, and
processes that the Secretary will use for selecting and
evaluating--
``(A) during initial stages of model development;
``(B) prior to testing under section (b)(1);
``(C) prior to modification of non-contractual
models under section (b)(3)(B); and
``(D) following evaluation of a model under section
(b)(4) and prior to rulemaking under section (c).
Such notice shall explain the basis for the Secretary's
determination that the conditions set forth in subsection (c)
have been met. Additionally, the notice shall explain the basis
for selection and the standards established by the Secretary
under the regulations issued under paragraph (1), and any
additional factors that will be used to test the model's impact
on quality of care, patient-centeredness, and innovation. The
notice shall provide a minimum 45-day period for public
comment. The Secretary shall take stakeholder comments into
consideration when determining whether or how to refine the
model or whether to proceed with testing under subsection
(b)(1).
``(7) Consultation.--In carrying out the duties under this
section, the CMI shall consult representatives of relevant
Federal agencies, and clinical and analytical experts with
expertise in medicine and health care management, specifically
such experts with expertise in--
``(A) the health care needs of minority, rural, and
underserved populations; and
``(B) the financial needs of safety net, community
based, rural, and critical access providers, including
federally qualified health centers.
The CMI shall use open door forums or other mechanisms to seek
external feedback from interested parties and incorporate that
feedback into the development of models.''.
SEC. 5. REESTABLISHING JUDICIAL REVIEW.
Section 1115A(d)(2) of the Social Security Act (42 U.S.C.
1315a(d)(2)) is amended--
(1) in the matter preceding subparagraph (A), by inserting
after ``or otherwise'' the following: ``(except as may be
necessary to enforce requirements of this section or other laws
or constitutional provisions intended to protect beneficiaries
of affected programs)'';
(2) by striking subparagraph (C);
(3) in subparagraph (D), by adding at the end ``; and'';
(4) by redesignating subparagraph (D) as subparagraph (C);
(5) in subparagraph (E), at the end, by striking ``; and''
and inserting a period;
(6) by redesignating subparagraph (E) as subparagraph (D);
and
(7) by striking subparagraph (F).
SEC. 6. REVISION OF REPORTING REQUIREMENT.
Section 1115A(g) of the Social Security Act (42 U.S.C. 1315a(g)) is
amended--
(1) by striking ``and not less than once every other year
thereafter'' and inserting ``and, for years before 2020, not
less than once biennially (and, for years beginning with 2020,
not less than annually) thereafter''; and
(2) by adding at the end the following new sentence: ``With
respect to 2020 and each subsequent year, the Secretary shall
submit each such report by not later than December 15 of such
year.''.
SEC. 7. ADDRESSING OVERLAP IN VALUE BASED CARE PROGRAMS.
(a) In General.--
(1) CMI.--Section 1115A(a)(5) of the Social Security Act
(42 U.S.C. 1315a(a)(5)) is amended by adding at the end the
following new sentence: ``In establishing such limits, the
Secretary shall take into account payment and service delivery
models in progress in such geographic areas.''.
(2) Repeal of medicare duplication prohibition.--Section
1899(b)(4) of the Social Security Act (42 U.S.C. 1395jjj(b)) is
amended by striking subparagraph (A).
(b) Report.--Not later than 60 days after the date of the enactment
of this Act, the Secretary of Health and Human Services shall conduct
an assessment and submit to Congress a report on alternative payment
model overlap under the Medicare program under title XVIII of the
Social Security Act. Such report shall include a description of and
recommendations relating to--
(1) any issues regarding the existence of multiple
alternative payment model participation opportunities for
health care providers; and
(2) obstacles created by competing incentives with respect
to alternative payment models.
SEC. 8. GAO REPORT.
Not later than 12 months after the date of enactment of this Act,
the Comptroller General of the United States shall submit to Congress a
report on the efforts of the Center for Medicare and Medicaid
Innovation to attract, retain, and develop emerging experts, including
under-represented individuals in medicine, such as women, racial and
ethnic minorities, and other groups. Such report shall include an
analysis of the impact of the existing authority provided to the Center
for Medicare and Medicaid Innovation to address workforce shortages and
gaps in priority areas.
SEC. 9. MODELS SPECIFICALLY TO IMPROVE QUALITY OF CARE.
(a) Clarification of Model Eligibility.--Section 1115A of the
Social Security Act (42 U.S.C. 1315a) is amended--
(1) in subsection (a)(1)--
(A) by striking ``while preserving or enhancing the
quality of care'' and inserting ``or to enhance quality
of care''; and
(B) by striking ``also'' before ``improve''; and
(2) in subsection (b)(2)(A) by inserting after the second
sentence the following new sentence: ``The Secretary may also
focus on models solely aimed at practices to significantly
improve the care and health outcomes of individuals receiving
benefits under the applicable title in anticipation that
quality of care benefits and potential direct or indirect
savings will accrue to the Medicare or Medicaid program.''.
(b) Additional Opportunity.--Section 1115A(b)(2)(B) of the Social
Security Act (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end
the following new clause:
``(xxviii) Implementing newly recognized
and evidence-based, professionally supported
care delivery practices and bundles to improve
the efficient and effective delivery of
hospital-based care and lead to enhanced
patient outcomes, reductions in readmissions,
or avoidance of costly medical errors or
complications.''.
(c) Inclusion of Indirect Savings.--Section 1115A(b)(3)(A) of the
Social Security Act (42 U.S.C. 1315a(b)(3)(A)) is amended by inserting
at the end ``or that savings cannot be made indirectly over time when
testing quality of care delivery models.''.
(d) Evaluating Quality of Care.--Section 1115A(b)(4) of the Social
Security Act (42 U.S.C. 1315a(b)(4)) is amended--
(1) in subparagraph (A), by amending clause (i) to read as
follows:
``(i) the quality of care furnished under
the model, including the measurement of
patient-level outcomes, patient-centeredness,
and any unintended consequences, such as access
to services, using criteria determined
appropriate by the Secretary for each model;
and''; and
(2) in subparagraph (C), by striking ``and'' before
``patient-centered care'' and inserting ``, are appropriate to
issues of quality outcomes related to the medical conditions
under study, and are''.
SEC. 10. EFFECTIVE DATE.
Except as otherwise provided in the previous sections of this Act
(or the amendments made by such sections), such amendments shall apply
with respect to the testing, expansion, or modification of models on or
after January 1, 2020.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, 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.
Referred to the Subcommittee on Health.
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