Sponsors (19)
The bill expands specialty care access in rural and underserved areas through coordinated telehealth and large nonprofit networks with data-driven evaluation, but does so in ways that may exclude smaller providers, concentrate decision-making, create privacy risks, and add funding/administrative constraints.
Medicare, Medicaid/CHIP enrollees and other patients in rural or 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 resource sharing and service capacity in rural areas.
Required data collection and evaluation of the telehealth model can improve measurement of outcomes and inform future Medicare and Medicaid policy decisions.
Restricting eligible networks to 501(c)(3) nonprofit organizations with at least 50 entities risks excluding smaller local providers and reducing participation options and local control in many communities.
Giving the Secretary sole authority to specify which specialty services are eligible could leave some communities without local access to certain specialties if those services are not selected.
Mandating substantial data collection and exchange raises patient privacy and security risks if safeguards are inadequate, potentially exposing sensitive health information.
Based on analysis of 2 sections of legislative text.
Requires CMMI to test a telehealth-focused Specialty Health Care Services Access Model contracting with nonprofit provider networks to serve eligible Medicare and Medicaid/CHIP patients in rural or underserved areas.
Introduced April 1, 2025 by Jodey Cook Arrington · Last progress April 1, 2025
Requires the Center for Medicare & Medicaid Innovation (CMI) to create and test a new Specialty Health Care Services Access Model that uses telehealth and other digital tools to expand specialty care access for eligible Medicare and Medicaid/CHIP beneficiaries living in rural or underserved areas. The model will contract with nonprofit provider networks made up of at least 50 covered entities (such as FQHCs, rural health clinics, critical access hospitals), with at least half located in rural areas, and will require data-sharing and coordination with patients' primary care providers. Funding for the model is subject to applicable appropriations rules.