Sponsors (2)
This is not an official government website.
Copyright © 2026 PLEJ LC. All rights reserved.
Creates a five-year Medicare demonstration (Oct 1, 2025–Sept 30, 2030) testing hospital-led models to better treat people with co-occurring mental and physical health conditions and to address related social needs. Participating hospitals must submit innovation plans, accept an annualized payment arrangement (e.g., lump-sum, capitation, or risk-bearing), join a learning collaborative, meet quality and reporting requirements, and may face repayments for noncompliance. The Secretary of Health and Human Services must run the program, identify and share best practices, explore payment reforms under Medicare and Medicaid, and report to Congress with an evaluation within one year after the program ends.
The bill funds a time‑limited demonstration to better integrate care and address health equity for vulnerable patients while giving hospitals predictable implementation funding and spreading best practices — but it exposes providers to financial and administrative risks and may not be sustained or scaled nationwide without further Congressional action.
Medicare beneficiaries with co-occurring mental and physical conditions (and other patients with chronic conditions) will receive coordinated, integrated care models designed to improve access and health outcomes.
Low‑income, Medicaid‑enrolled, and uninsured individuals will gain stronger social‑care linkages and supports that can reduce non‑medical public expenditures and address social drivers of health.
Participating hospitals and health systems receive predictable annualized payments (lump‑sum, capitation, or risk‑bearing) to fund implementation of new integrated services, making planning and investment easier.
Participating hospitals may assume financial risk under the payment arrangements and could face repayments or losses if performance or contract terms are not met.
The demonstration is time‑limited (2025–2030), so promising care models may lack long‑term funding or national scale unless Congress acts on program recommendations.
Implementation and reporting requirements add administrative burden for participating hospitals, which could divert staff time and resources away from direct patient care.
Introduced April 2, 2025 by Brendan Francis Boyle · Last progress April 2, 2025