S. 1248

119th CONGRESS 1st Session

To amend title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries.

IN THE SENATE OF THE UNITED STATES · April 2, 2025 · Sponsor: Mr. Mullin · Committee: Committee on Finance

S. 1248
- SEC. 1. Short title
- SEC. 2. Requiring the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries

SEC. 1. Short title

This Act may be cited as the or the .

SEC. 2. Requiring the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries

(a) In general
- Section 1115A of the Social Security Act () is amended— 42 U.S.C. 1315a
- In general
  - in subsection (b)(2)—
    - in subparagraph (A), in the third sentence, by inserting before the period at the end; and
      - (xxviii) The Specialty Health Care Services Access Model described in subsection (h).
    - in subparagraph (B), by adding at the end the following new clause:
    - (h) Specialty Health Care Services Access Model
      - (1) In general
        
        For purposes of subsection (b)(2)(B)(xxviii), the Specialty Health Care Services Access Model described in this subsection is a model under which the Secretary enters into an agreement with one or more provider networks selected in accordance with paragraph (2) for purposes of furnishing specialty health care services (as specified by the Secretary) to eligible individuals through the use of digital modalities (such as telehealth and other remote technologies) in coordination with such individuals’ primary care providers.
      - (2) Selection of provider networks
        
        The Secretary shall select one or more networks of providers for purposes of furnishing services under the model described in paragraph (1). Any such network so selected shall—
        
        be comprised of at least 50 Federally qualified health centers, rural health clinics, critical access hospitals, or rural emergency hospitals, at least half of which are located in rural areas (as defined by the Administrator of the Health Resources and Services Administration);
        
        be a nonprofit entity under of the Internal Revenue Code of 1986; section 501(c)(3)
        
        have an established record of supporting the delivery of health care in rural and underserved communities in multiple regions throughout the country; and
        
        have the ability to collect, exchange, and evaluate data for purposes of the model described in paragraph (1).
      - (3) Eligible individual defined
        
        For purposes of this subsection, the term eligible individual means an individual—
        
        who—
        
        (i) is entitled to benefits under part A of title XVIII or enrolled under part B of such title; or
        
        (ii) is enrolled under the Medicaid program under title XIX or the Children's Health Insurance Program under title XXI and meets all components for eligibility for medical assistance, child health assistance, or pregnancy-related assistance (as applicable), including those described in sections 1902(a)(46)(B) and 1137(d); and
        
        who is located in a rural or underserved area (as specified by the Secretary).
  - by adding at the end the following new subsection:
(b) Limitation
- Any amounts appropriated or allocated to carry out the amendments made by this section shall be subject to the requirements contained in for funds for programs authorized under sections 330 through 340 of the Public Health Service Act (42 U.S.C. 254b through 256). Public Law 117–328