Sponsors (23)
The bill expands access to specialty care for rural and underserved Medicare/Medicaid patients through coordinated telehealth and promotes data-driven evaluation, but concentrates delivery in large nonprofit networks, vests key choices with the Secretary, raises privacy risks, and could add funding conditions for local implementers.
Medicare and Medicaid/CHIP enrollees in rural and underserved communities gain improved access to specialty care through telehealth coordinated with their primary care providers, reducing travel burdens and improving continuity of care.
Rural health centers, federally qualified health centers (FQHCs), critical access hospitals, and rural emergency hospitals can strengthen services by joining larger nonprofit networks that receive model contracts, potentially improving financial stability and clinical capacity.
Required data collection and evaluation of the telehealth model will generate evidence on outcomes and program performance, informing future Medicare and Medicaid policy decisions and program improvements.
Limiting eligible networks to large 501(c)(3) nonprofit organizations with at least 50 entities may exclude smaller local providers and reduce participation options and local control in some communities.
Requiring substantial data collection and exchange increases the risk to patient privacy and data security unless robust protections and oversight are implemented.
Giving the Secretary sole authority to specify which specialty services are eligible for the model could leave some local areas without access to certain specialties if those services are not selected.
Based on analysis of 2 sections of legislative text.
Directs CMI to test a nonprofit-led telehealth specialty care model serving eligible Medicare and Medicaid/CHIP beneficiaries in rural and underserved areas.
Official title: 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.
Introduced April 1, 2025 by Jodey Cook Arrington · Last progress April 1, 2025
Creates a new Specialty Health Care Services Access Model that the Center for Medicare & Medicaid Innovation (CMI) must test. The model requires CMI to contract with one or more nonprofit provider networks to deliver specialty care services via digital modalities (for example, telehealth) in coordination with primary care providers to eligible Medicare and Medicaid/CHIP beneficiaries in rural or underserved areas. Provider networks must include at least 50 covered entities (FQHCs, rural health clinics, critical access hospitals, or rural emergency hospitals), have a record of serving rural or underserved communities across regions, be nonprofit 501(c)(3) organizations, and demonstrate data collection and exchange capabilities. Funding/appropriations are subject to requirements that apply to certain public health program funds under 42 U.S.C. 254b–256.