The Center for Medicare and Medicaid Innovation (CMMI), a division of the Centers for Medicare and Medicaid Services (CMS), has been actively experimenting with new health delivery and payment models in the past two years, attracting the attention of Congress. Specifically, U.S. Representatives Terri Sewell (D-AL), Adrian Smith (R-NE), Tony Cardenas (D-CA) and Tom Shimkus (R-IL) introduced legislation seeking to increase the agency’s transparency and accountability. The legislation is named the Strengthening Innovation in Medicare and Medicaid Act (H.R. 5741). ANCOR monitors news around CMMI because some of the value-based models it explores could set precedent for Medicaid programs in the future.
As written in U.S. Representatives’ Sewell and Smith’s press release:
“The current CMMI framework allows the executive branch to waive certain Medicare and Medicaid rules to test controversial approaches to deliver care without assurance that these changes will not have a negative effect on health care delivery outcomes. To address these concerns, the bill would establish guardrails, increase overall transparency and incorporates greater opportunity for public input.
Specifically, the Strengthening Innovation in Medicare and Medicaid Act:
Helps ensure the CMMI model functions as Congress intended by:
Requiring the Secretary of Health and Human Services to develop and implement a plan to monitor the effect of a model on applicable individuals, and mitigate any adverse impact, including reductions in care or reduced access to care; and
Ensuring the plan assesses and tracks the impact of delivery and payment models on health disparities.
Requiring the Secretary to mitigate any adverse impact that her or she determines could affect health care outcomes.
Increases transparency when assessing CMMI rulemaking and payment models by:
Creating an expedited Congressional disapproval process for models.
Creating a new process for public input, including advance public notice and an opportunity for stakeholder input and public comments regarding the establishment, testing, implementation, evaluation, and expansion of a health care delivery model.
And aims to reduce burden on rural health care providers while improving efficiency and overall outcomes by:
Requiring CMMI to consult representatives of relevant federal agencies, clinical and analytical experts with expertise in medicine and health care management, specifically those with expertise in:
The health care needs of minority, rural and underserved populations, and
The financial needs of safety net, community based, rural and critical access providers, including federally qualified health centers.
Providing hardship exemptions in the case that requirements by CMMI result in undue economic hardship for a provider or supplier, or loss of access to such provider for vulnerable populations.”
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