HouseH.R. 10706119th Congress
Strengthening Innovation in Medicare and Medicaid Act
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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10706 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 10706
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
October 1, 2026
Mr. Smith of Nebraska 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. SENSE OF CONGRESS.
It is the sense of Congress that:
(1) The Center for Medicare and Medicaid Innovation (CMI)
represents a valuable tool for testing innovative health care
payment and service delivery models which can improve the
coordination, quality, and efficiency of health care services.
(2) The model testing process is intended to test concepts
on a limited scale first in Phase I, then assess initial
results, and, if results merit, expand the model to a larger
test in Phase II to confirm the initial results.
(3) Starting model testing on a limited scale, assessing
results, and then expanding the model to confirm initial
results protects the integrity of the Medicare program by
minimizing unintentional losses or negative impacts to the
patients or providers participating in Phase I model testing.
(4) CMI should focus its attention on models most likely to
succeed and should continually assess models and terminate
those which are not generating results in keeping with its
purpose--lowering costs while maintaining or preserving patient
outcomes.
(5) Mandatory models may be necessary to test certain
payment models but should be used judiciously and be as limited
in scope as possible to minimize accidental adverse impacts.
(6) As CMI may waive certain provisions of Medicare
regulations, Congress may block models which functionally alter
or change the underlying existing statutes.
SEC. 3. 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, the Secretary shall limit
testing of a Phase I model--
``(A) to a period not to exceed 5 years; and
``(B) to the lesser of 10 percent of applicable
individuals or 500,000 beneficiaries.''.
(b) Cap on Phase I Model Testing.--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) Phase i model limitations.--During each fiscal year
starting with fiscal year 2027, CMI shall initiate Phase I
testing of no more than 6 new models each fiscal year.
Additionally, CMI shall not concurrently test more than 5 Phase
I models which involve mandatory, involuntary, or compulsory
participation.''.
(c) Required Waivers for Hardship.--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) Hardship waivers.--Not later than 60 days after the
enactment of the Strengthening Innovation in Medicare and
Medicaid Act, the Secretary shall develop and implement a plan
to allow applicable providers of services or supplies 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 healthcare services or supplies for vulnerable
populations.''.
(d) Monitoring Impact.--Section 1115A(a) of the Social Security Act
(42 U.S.C. 1315a(a)), as amended by subsections (a), (b), and (c), is
further amended by adding at the end the following new paragraph:
``(9) Monitoring impact.--Not later than 60 days after 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; and
``(B) mitigate any adverse impact that the
Secretary determines could affect beneficiary
health.''.
SEC. 4. IMPLEMENTATION OF TESTING AND EXPANSION OF MODELS WITH
CONGRESSIONAL INACTION.
(a) In General.--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 subsections (b) and (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 a
model proposed in a report submitted under subparagraph
(A) shall be carried out by the Secretary if Congress
does not, within 45 days of receiving such report, 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
paragraphs of this subsection, `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) 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; but 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
subsection (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
subsection (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.''.
(b) Effective Date.--The amendments made by this section shall
apply beginning on the date of the enactment of this Act.
SEC. 5. PUBLIC INPUT.
Section 1115A(d) of the Social Security Act (42 U.S.C. 1315a(d)) is
amended by section 3, is further amended by adding at the end of the
following new paragraphs:
``(5) 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
section 1115A(b) and (c). 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 subsection (b)(1);
``(C) prior to modification of non-contractual
models under subsection (b)(3)(B); and
``(D) following evaluation of a model under
subsection (b)(4) and prior to rulemaking under
subsection (c).
Such notice shall explain the basis for the Secretary's
determination that the conditions set forth in section 1115A(c)
of the Social Security Act (42 U.S.C. 1315a(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).
``(6) Consultation.--In carrying out the duties under this
subsection, 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 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. 6. REESTABLISHING JUDICIAL REVIEW.
(a) In General.--Section 1115A(d)(2) of the Social Security Act (42
U.S.C. 1315(d)(2)) is amended--
(1) in the matter preceding subparagraph (A), by inserting
``(except as may be necessary to enforce the requirements of
this section or other laws or constitutional provisions
intended to protect beneficiaries of affected programs)'' after
``or otherwise'';
(2) by striking subparagraph (C);
(3) in subparagraph (D), by adding ``and'' at the end;
(4) in subparagraph (E), by striking ``; and'' and
inserting a period;
(5) by redesignating subparagraphs (D) and (E) as
subparagraphs (C) and (D), respectively; and
(6) by striking subparagraph (F).
(b) Effective Date.--The amendments made by this section shall
apply beginning on the date of the enactment of this Act.
SEC. 7. 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 2027, not
less than once biennially (and, for years beginning with 2027,
not less than annually) thereafter''; and
(2) by adding at the end the following new sentence: ``With
respect to 2027 and each subsequent year, the Secretary shall
submit each such report by not later than December 15 of such
year.''.
SEC. 8. 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) of the Social Security Act (42 U.S.C. 1395jjj(b)) is
amended by striking paragraph (4)(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) appropriate participation in multiple alternative
payment models for health care providers;
(2) feasibility of adequate evaluation of alternative
payment models if participants are participating in multiple
arrangements; and
(3) obstacles created by competing incentives with respect
to alternative payment models.
SEC. 9. MODEL ELIGIBILITY AND 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), 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
implementing practices to demonstrate ways to significantly improve the
care, patient safety, 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 over time
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
``or that savings cannot be made indirectly over time when testing
quality of care delivery models'' before the period at the end.
(d) Availability of Actuarial Assumptions and Data.--Section 1115A
of the Social Security Act (42 U.S.C. 1315a) is amended--
(1) in subsection (b)(3)(B)--
(A) by redesignating clauses (i) through (iii) as
subclauses (I) through (III), respectively, and
adjusting the margins accordingly;
(B) by striking ``The Secretary shall'' and
inserting the following:
``(i) In general.--The Secretary shall'';
and
(C) by adding at the end the following new clause:
``(ii) Publicly available information.--The
Secretary shall provide to each provider of
services and supplier participating in a model,
and include in any rules promulgated with
respect to the consideration of such model for
termination or modification, the assumptions
and data used by the Chief Actuary of the
Centers for Medicare & Medicaid Services as the
basis for making (or declining to make) the
certification described in clause (i) with
respect to such model.''; and
(2) in subsection (c), in the flush-left text at the end,
by adding at the end the following new sentence: ``The
Secretary shall provide to each provider of services and
supplier participating in a model or demonstration project, and
include in any rules promulgated with respect to the
consideration of such model for expansion, the assumptions and
data used by the Chief Actuary of the Centers for Medicare &
Medicaid Services as the basis for making (or declining to
make) the certification described in paragraph (2) with respect
to such model.''.
(e) 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. 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 that contains an analysis of--
(1) the efforts of the Center for Medicare and Medicaid
Innovation to attract, retain, and develop emerging experts;
(2) the impact of the existing authority provided to the
Center for Medicare and Medicaid Innovation to address
workforce shortages and gaps in priority areas; and
(3) the similarities and differences between the authority
provided to the Center for Medicare and Medicaid Innovation
under section 1115A of the Social Security Act (42 U.S.C.
1315a) and the authority provided to the Secretary of Health
and Human Services under section 402 of the Social Security
Amendments of 1967 (42 U.S.C. 1395b-1).
SEC. 11. EFFECTIVE DATE.
Except as otherwise provided in the previous sections of this Act
(and 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, 2027.
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