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Creates a new Specialty Health Care Services Access Model under the Social Security Act to test using telehealth and other digital methods to expand specialty care access for Medicare, Medicaid, and CHIP beneficiaries in rural and underserved areas. The model directs the Secretary to contract with one or more qualifying provider networks that meet size, nonprofit, rural service, and data-capability requirements and to limit use of program funds to authorities tied to certain Public Health Service Act programs. The model sets eligibility rules for which beneficiaries can participate, specifies provider network selection criteria (including nonprofit status, minimum size, rural/underserved focus, and data capacity), and establishes that the pilot operate under the Section 1115A testing framework to evaluate outcomes and payment approaches for digital specialty care delivery.
Amend Section 1115A(b)(2) of the Social Security Act by inserting new clause (xxviii) in subparagraph (B) to reference the Specialty Health Care Services Access Model described in a new subsection (h).
Amend Section 1115A(b)(2)(A) third sentence by inserting text before the final period (text of insertion not provided in this section chunk).
Create a new subsection (h) titled 'Specialty Health Care Services Access Model' that defines the model for furnishing specialty health care services via digital modalities in coordination with patients' primary care providers.
Authorize the Secretary to enter into agreements with one or more selected provider networks to furnish specialty health care services (as specified by the Secretary) to eligible individuals through digital modalities (such as telehealth and other remote technologies) in coordination with individuals’ primary care providers.
Require the Secretary to select one or more provider networks that meet specific criteria (see next items) to participate in the model.
Who is affected and how:
Medicare, Medicaid, and CHIP beneficiaries in rural and underserved areas: Directly affected by increased access to specialty care services delivered via telehealth and other digital methods. Eligible beneficiaries could see shorter wait times, fewer long-distance trips, and improved continuity for specialty consultations and follow-up care.
Nonprofit provider networks that meet the statute’s selection criteria: May be eligible to contract as demonstration sites; they will need to demonstrate minimum size, rural reach, and digital/data capabilities. Participating networks may receive new payment models, technical expectations, and evaluation obligations.
Health care providers and specialist clinicians: Could gain new telehealth-based referral and consultation pathways, new payment arrangements, and requirements for reporting and care coordination. Some workload shifts to virtual care and potential new revenue streams may occur.
State Medicaid programs and CHIP administrators: May interact with the model for beneficiary enrollment and coordination; however, the model runs under CMMI authority, so it is a federal test with implications for state program operations and potential future adoption.
Patients and communities: Expected benefits include improved specialty access, reduced travel burden, and earlier specialty input for conditions that would otherwise require long-distance referral. Risks/constraints include digital access gaps (broadband, device access, digital literacy), potential variability in quality across networks, and the need for robust data privacy and interoperability safeguards.
Federal agencies (HHS/CMS/CMMI): Will need to set up contracting, oversight, evaluation, and reporting processes for the model, including monitoring outcomes and ensuring compliance with PHSA-linked rules.
Overall effect: The provision creates a focused, federally run demonstration that could improve specialty access in underserved areas if networks are adequately resourced and beneficiaries have digital access; it also generates evidence for potential broader policy changes. Implementation will require investment in data/reporting, attention to the digital divide, coordination with Medicaid/CHIP programs, and careful evaluation design.
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Read twice and referred to the Committee on Finance.
Introduced April 2, 2025 by Markwayne Mullin · Last progress April 2, 2025
EASE Act of 2025
Read twice and referred to the Committee on Finance.
Introduced in Senate