Summary

Requires the Center for Medicare and Medicaid Innovation (CMMI) to create and run a Specialty Health Care Services Access Model that uses digital modalities (for example, telehealth) to deliver specialty care to eligible Medicare and Medicaid/CHIP enrollees in rural and underserved areas. The model must operate through one or more nonprofit provider networks that meet specified size, composition, geographic, and data-capability requirements and coordinate with patients' primary care providers. Sets eligibility to Medicare Part A or B beneficiaries and Medicaid/CHIP enrollees located in Secretary-defined rural or underserved areas, and ties implementation funding to the same requirements that govern certain Public Health Service Act programs; the short title provision simply names the Act but adds no substantive requirements.

Key Points

• Mandates CMMI create and run a telehealth-focused Specialty Health Care Services Access Model for specialty care.
• Model serves eligible Medicare Part A/B and Medicaid/CHIP enrollees in Secretary-defined rural or underserved areas.
• Services must be delivered via digital modalities and coordinated with patients' primary care providers.
• Selected provider networks must be nonprofit (501(c)(3)) and include at least 50 participating rural/primary care entities.
• At least half of participating entities in a network must be located in rural areas and networks must be multiregional.
• Networks must demonstrate data collection, exchange, and evaluation capacities.
• Implementation funding is subject to the administrative/funding rules that apply to certain Public Health Service Act programs.
• Short title provision creates no substantive programmatic effects or funding.
• The bill sets selection and eligibility rules but leaves operational details — like payment, timelines, and selection mechanics — to HHS/CMMI.

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