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Introduced April 1, 2025 by Jodey Cook Arrington · Last progress April 1, 2025
Creates a new CMMI testing model called the Specialty Health Care Services Access Model that contracts nonprofit provider networks to deliver specialty care to eligible Medicare, Medicaid, and CHIP beneficiaries in rural and underserved areas using digital modalities (for example, telehealth) coordinated with primary care. Sets selection criteria for provider networks (including at least 50 participating entities, nonprofit status, multi-region rural/underserved experience, and data capabilities) and ties implementation funding to requirements applicable to federal health center program funds.
The bill expands specialty telehealth access for Medicare/Medicaid beneficiaries in rural and underserved areas via nonprofit-led networks and requires evaluation to inform policy, but its impact may be limited by broadband gaps, eligibility restrictions that exclude some local providers, and administrative/implementation hurdles.
Medicare and Medicaid/CHIP enrollees in rural and underserved areas gain increased access to specialty care via telehealth, reducing the need to travel long distances for specialist visits.
Federally qualified health centers, rural clinics, critical access hospitals, and other community nonprofit networks can coordinate with primary care to integrate specialty telehealth, strengthening local care capacity and continuity of services in underserved areas.
State governments and health systems will receive required data collection and evaluation from the model, improving quality measurement and providing evidence to inform wider policy or program expansion if successful.
Rural and low-connectivity Medicare/Medicaid beneficiaries may not benefit fully because telehealth delivery depends on broadband and technology access that is lacking in some areas.
Small local providers and for-profit providers could be excluded from participating because the program limits selected networks to 501(c)(3) nonprofits and large multi-entity networks, reducing local options and competition.
Requiring at least half of participating entities to be in rural areas and expecting multi-region reach may delay implementation in regions that do not already have such networks.