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Read twice and referred to the Committee on Finance.
Introduced April 2, 2025 by Michael F. Bennet · Last progress April 2, 2025
Creates a new Medicare demonstration to test hospital‑led models that integrate care for people with both mental and physical health conditions and address social needs that affect health. The program runs from October 1, 2025 through September 30, 2030, requires participating hospitals to submit plans and quality metrics, establishes a learning collaborative, uses negotiated annualized payments, and directs the Secretary to evaluate results and report to Congress after the demonstration ends. The goal is to improve care and outcomes—especially in vulnerable and underserved communities—by supporting hospital innovations that coordinate behavioral health, physical health, and social supports, while collecting data on cost, quality, and equity impacts.
Establish a demonstration program (called the program) to test and evaluate innovations implemented by eligible hospitals in furnishing items and services to applicable individuals with mental and physical health comorbidities, including addressing adverse social determinants of health.
The Secretary must identify, validate, and share evidence-based best practices and models that improve care and outcomes for applicable individuals in vulnerable communities, including by addressing social determinants of health.
The Secretary must assist in identifying potential payment reforms under Title XVIII and Title XIX that could help implement the improvements tested by the program.
The program shall operate beginning October 1, 2025 and end no later than September 30, 2030.
An eligible hospital that chooses to participate must enter into an agreement with the Secretary to carry out program activities. The agreement must include a proposed plan and an annualized payment arrangement.
Primary affected parties are hospitals that participate in the demonstration and Medicare beneficiaries who have both mental and physical health conditions. Participating hospitals will need to design or expand integrated care models, track and report quality metrics, and negotiate payment arrangements with CMS—adding administrative work but potentially receiving bundled/annualized payments intended to support wraparound services and social‑needs interventions. Medicare beneficiaries in the targeted populations, particularly those in underserved or vulnerable communities, could see more coordinated care, better access to behavioral health and social supports, and potentially fewer avoidable hospitalizations or emergency visits. CMS and federal staff will need to manage the competitive selection/approval process, payment negotiations, data collection, the learning collaborative, and the evaluation and reporting obligations. Payers beyond Medicare (state Medicaid programs, commercial insurers) could observe outcomes and potentially adopt similar approaches. Risks include administrative burden for hospitals, variability in negotiated payments and models that could complicate comparisons, limited generalizability if participant mix is narrow, and unclear funding mechanics since no specific appropriations are detailed. The demonstration has equity focus—targeting vulnerable communities—which could produce useful evidence about reducing disparities if metrics and sampling are designed accordingly.
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Read twice and referred to the Committee on Finance.
Introduced in Senate