Sponsors (2)
The bill provides targeted funding and evidence-building for hospital-led integrated care that could improve outcomes for Medicare and vulnerable communities, but it exposes hospitals to financial and administrative risk and may leave smaller providers and long-term scaling gaps unaddressed.
Medicare beneficiaries with co-occurring mental and physical conditions could receive coordinated, evidence-based hospital-led care that reduces emergency visits and hospitalizations.
Hospitals in vulnerable, rural, and underserved communities can get dedicated annualized payments or lump-sum support to implement integrated medical, behavioral, and social determinant interventions.
The program could identify and pilot payment reforms for Medicare and Medicaid that expand coverage of care coordination, home- and community-based services, and supportive social services for beneficiaries.
Hospitals accepting funding may face financial risk or repayment obligations if innovations fail or agreed outcomes are not met.
Smaller providers that do not qualify as eligible hospitals may be excluded from funding and the learning collaborative, leaving some rural and small community providers and their patients without support.
Participating hospitals will face additional administrative burdens from required data collection, quality measurement, and collaborative participation.
Based on analysis of 2 sections of legislative text.
Creates a Medicare demonstration (Oct 1, 2025–Sep 30, 2030) testing hospital innovations for mental/physical comorbidities and social determinants, with learning and payment testing.
Introduced April 2, 2025 by Brendan Francis Boyle · Last progress April 2, 2025
Creates a Medicare demonstration that tests hospital-led innovations to identify, treat, and coordinate care for people who have, or are at risk of, co-occurring mental and physical health conditions and related social needs. The program requires participating hospitals to submit approved plans and quality metrics, join a learning collaborative, receive annualized payments to implement innovations, and helps HHS identify best practices and possible Medicare and Medicaid payment reforms. The demonstration runs from October 1, 2025 through no later than September 30, 2030; participating hospitals must enter into agreements with the Secretary that include payment arrangements, evidence requirements, quality measures, and safeguards against supplanting existing activities, with repayment required for noncompliance.