Strengthening Innovation in Medicare and Medicaid Act

I 116TH CONGRESS 2D SESSION H. R. 5741 To amend title XI of the Social Security Act to clarify parameters for model testing and add accountability to model expansion under the Cen- ter for Medicare and Medicaid Innovation, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 3, 2020 Ms. SEWELL of Alabama (for herself, Mr. SMITH of Nebraska, Mr. CA´RDENAS, Mr. SHIMKUS, Mr. WENSTRUP, and Mr. SCHRADER) intro- duced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the juris- diction of the committee concerned A BILL To amend title XI of the Social Security Act to clarify parameters for model testing and add accountability to model expansion under the Center for Medicare and Medicaid Innovation, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Strengthening Innova- 4 tion in Medicare and Medicaid Act’’. 5 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 2 •HR 5741 IH SEC. 2. DEFINING CMI MODEL TESTING PARAMETERS. 1 (a) SCOPE AND DURATION OF MODELS.—Section 2 1115A(a) of the Social Security Act (42 U.S.C. 1315a(a)) 3 is amended by adding at the end the following new para- 4 graph: 5 ‘‘(6) SCOPE AND DURATION OF MODELS TEST- 6 ED.—Beginning on or after the date of the enact- 7 ment of the Strengthening Innovation in Medicare 8 and Medicaid Act, for purposes of testing new pay- 9 ment and service delivery models or expanding pay- 10 ment and service deliver models under this section, 11 the Secretary shall limit testing of a model— 12 ‘‘(A) to a period not to exceed 5 years; and 13 ‘‘(B) no more applicable individuals than 14 necessary to obtain a statistically valid sam- 15 ple.’’. 16 (b) MODEL REQUIREMENT WAIVERS FOR HARD- 17 SHIP.—Section 1115A(a) of the Social Security Act (42 18 U.S.C. 1315a(a)), as amended by subsection (a), is fur- 19 ther amended by adding at the end the following new para- 20 graph: 21 ‘‘(7) HARDSHIP WAIVERS.—Not later than 60 22 days after the date of the enactment of the 23 Strengthening Innovation in Medicare and Medicaid 24 Act, the Secretary shall develop and implement a 25 plan to allow providers of services and suppliers to 26 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 3 •HR 5741 IH request a waiver from any requirement of a model 1 if the Secretary determines that such requirement 2 would result in undue economic hardship to such 3 provider or supplier or loss of access to such pro- 4 vider or supplier for vulnerable populations.’’. 5 (c) MONITORING IMPACT.—Section 1115A(a) of the 6 Social Security Act (42 U.S.C. 1315a(a)), as amended by 7 subsections (a) and (b), is further amended by adding at 8 the end the following new paragraph: 9 ‘‘(8) MONITORING IMPACT.—Not later than 60 10 days after the date of the enactment of the 11 Strengthening Innovation in Medicare and Medicaid 12 Act, the Secretary shall develop and implement a 13 plan to— 14 ‘‘(A) monitor continuously and on a real- 15 time basis the effect of a model under sub- 16 section (b) on applicable individuals, and miti- 17 gate any adverse impact, such as inappropriate 18 reductions in care or reduced access to care; 19 ‘‘(B) assess and track the impact of deliv- 20 ery and payment models on health disparities, 21 using existing measures such as the National 22 Quality Forum Healthcare Disparities and Cul- 23 tural Competency Measure; and 24 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 4 •HR 5741 IH ‘‘(C) mitigate any adverse impact that the 1 Secretary determines could affect beneficiary 2 health.’’. 3 SEC. 3. IMPLEMENTATION OF TESTING AND EXPANSION OF 4 MODELS WITH CONGRESSIONAL INACTION. 5 Section 1115A(d) of the Social Security Act (42 6 U.S.C. 1315a(d)) is amended by adding at the end the 7 following new paragraph: 8 ‘‘(4) IMPLEMENTATION OF TESTING AND EX- 9 PANSION OF MODELS WITH CONGRESSIONAL INAC- 10 TION.— 11 ‘‘(A) The Secretary shall transmit a pro- 12 posal for the testing, expansion, or modification 13 of a model under subsection (b) or (c), includ- 14 ing a proposed effective date and a summary of 15 the determinations and certification made under 16 paragraphs (1) through (3) of subsection (c), if 17 applicable, to the Committee on Ways and 18 Means and the Committee on Energy and Com- 19 merce of the House of Representatives and to 20 the Committee on Finance and the Committee 21 on Health, Education, Labor, and Pensions of 22 the Senate. 23 ‘‘(B) The testing, expansion, or modifica- 24 tion of model proposed in a report submitted 25 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 5 •HR 5741 IH under subparagraph (A) shall be carried out by 1 the Secretary if the Congress does not, within 2 45 days of receiving a report transmitted from 3 the Secretary detailing the proposed testing or 4 expansion including the proposed effective date 5 for such testing or expansion and a summary of 6 the determinations and certification made under 7 paragraphs (1) through (3), pass a joint resolu- 8 tion disapproving of the proposed testing or ex- 9 pansion in accordance with the following proce- 10 dure: 11 ‘‘(i) The succeeding subparagraphs of 12 this paragraph are enacted by Congress as 13 an exercise of the rulemaking power of the 14 Senate and the House of Representatives, 15 respectively, and as such they shall be 16 deemed a part of the rules of each House, 17 respectively, but applicable only with the 18 respect to the procedure to be followed in 19 that House in the case of resolutions de- 20 scribed in subparagraph (B). They shall 21 supersede other rules only to the extent 22 that they are inconsistent therewith. They 23 are enacted with full recognition of the 24 constitutional right of either House to 25 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 6 •HR 5741 IH change the rules (so far as relating to the 1 procedure of that House) at any time, in 2 the same manner and to the same extent 3 as in the case of any ruse of that House. 4 ‘‘(ii) For the purpose of the suc- 5 ceeding provisions of this subparagraph, 6 ‘‘resolution’’ means only a joint resolution, 7 the matter after the resolving clause of 8 which is as follows: ‘That Congress dis- 9 approves the model expansion requested 10 pursuant to section 1115A(c) of the Social 11 Security Act transmitted by the Secretary 12 on lllll, and such an expansion 13 shall not proceed.’, the blank space therein 14 being filled with the date on which the Sec- 15 retary’s message proposing such expansion 16 was delivered. 17 ‘‘(iii) Upon receipt of a report sub- 18 mitted to Congress under subparagraph 19 (c)(4), each House shall provide copies of 20 the report to the chairman and ranking 21 member of the Committee on Ways and 22 Means and the Committee on Energy and 23 Commerce of the House of Representatives 24 and to the Committee on Finance and the 25 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 7 •HR 5741 IH Committee on Health, Education, Labor, 1 and Pensions of the Senate. 2 ‘‘(iv) A resolution shall be referred to 3 the Committee on Ways and Means and 4 the Committee on Energy and Commerce 5 of the House of Representatives and to the 6 Committee on Finance and the Committee 7 on Health, Education, Labor, and Pen- 8 sions of the Senate. 9 ‘‘(v) If a committee to which has been 10 referred a resolution has not reported it 11 before the expiration of 10 legislative days 12 after its introduction, it shall then (but not 13 before) be in order to move to discharge 14 the committee from further consideration 15 of that resolution, or to discharge the com- 16 mittee from further consideration of any 17 other resolution with respect to the pro- 18 posed expansion which has been referred to 19 the committee. The motion to discharge 20 may be made only by a person favoring the 21 resolution, shall be highly privileged (ex- 22 cept that it may not be made after the 23 committee has reported a resolution with 24 respect to the same proposed expansion), 25 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 8 •HR 5741 IH and debate thereon shall be limited to not 1 more than 1 hour, to be divided equally be- 2 tween those favoring and those opposing 3 the resolution. An amendment to the mo- 4 tion is not in order, and it is not in order 5 to move to reconsider the vote by which 6 the motion is agreed to or disagreed to. If 7 the motion to discharge is agreed to or dis- 8 agreed to, the motion may not be renewed, 9 nor may another motion to discharge the 10 committee be made with respect to any 11 other resolution with respect to the same 12 proposed expansion. 13 ‘‘(vi) When the committee has re- 14 ported, or has been discharged from fur- 15 ther consideration of a resolution, it is at 16 any time thereafter in order (even though 17 a previous motion to the same effect has 18 been disagreed to) to move to proceed to 19 the consideration of the resolution. The 20 motion is highly privileged and is not de- 21 batable. An amendment to the motion is 22 not in order, and it is not in order to move 23 to reconsider the vote by which the motion 24 is agreed to or disagreed to. Debate on the 25 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 9 •HR 5741 IH resolution shall be limited to not more than 1 2 hours, which shall be divided equally be- 2 tween those favoring and those opposing 3 the resolution. A motion further to limit 4 debate is not debatable. An amendment to, 5 or motion to recommit, the resolution is 6 not in order, and it is not in order to move 7 to reconsider the vote by which the resolu- 8 tion is agreed to or disagreed to. 9 ‘‘(vii) Motions to postpone, made with 10 respect to the discharge from committee, 11 or the consideration of, a resolution and 12 motions to proceed to the consideration of 13 other business shall be decided without de- 14 bate. Appeals from the decision of the 15 Chair relating to the application of the 16 rules of the Senate or the House of Rep- 17 resentatives, as the case may be, to the 18 procedure relating to a resolution shall be 19 decided without debate. 20 ‘‘(viii) COORDINATION WITH ACTION 21 BY OTHER HOUSE.—If, before the passage 22 by one House of a joint resolution of that 23 House, that House receives from the other 24 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 10 •HR 5741 IH House a joint resolution, then the following 1 procedures shall apply: 2 ‘‘(I) The joint resolution of the 3 other House shall not be referred to a 4 committee. 5 ‘‘(II) With respect to a joint res- 6 olution of the House receiving the res- 7 olution, the procedure in that House 8 shall be the same as if no joint resolu- 9 tion had been received from the other 10 House, the vote on passage shall be 11 on the joint resolution of the other 12 House. 13 ‘‘(ix) If one House fails to introduce 14 or consider a joint resolution under this 15 section, the joint resolution of the other 16 House shall be entitled to expedited floor 17 procedures under this section. 18 ‘‘(x) If, following passage of the joint 19 resolution in the Senate, the Senate then 20 receives the companion measure from the 21 House of Representatives, the companion 22 measure shall not be debatable. 23 ‘‘(xi) If Congress passes a joint reso- 24 lution, the period beginning on the date 25 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 11 •HR 5741 IH the President is presented with the joint 1 resolution and ending on the date the 2 President takes action with respect to the 3 joint resolution shall be disregarded in 4 computing the 45-calendar day period de- 5 scribed in subparagraph (c)(4). 6 ‘‘(xii) If the President vetoes the joint 7 resolution— 8 ‘‘(I) the period beginning on the 9 date the President vetoes the joint 10 resolution and ending on the date the 11 Congress receives the veto message 12 with respect to the joint resolution 13 shall be disregarded in computing the 14 45-calendar day period described in 15 subparagraph (c)(4), and 16 ‘‘(II) debate on a veto message in 17 the Senate under this section shall be 18 1 hour equally divided between the 19 majority and minority leaders or their 20 designees.’’. 21 SEC. 4. PUBLIC INPUT AND CONSULTATION. 22 Section 1115A(d) of the Social Security Act (42 23 U.S.C. 1315a(d)), as amended by section 3, is further 24 VerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741 lotter on DSKBCFDHB2PROD with BILLS 12 •HR 5741 IH amended by adding at the end of the following new para- 1 graphs: 2 ‘‘(6) PUBLIC INPUT.—The Secretary shall use a 3 process involving advance public notice and an op- 4 portunity for stakeholder input and public comments 5 to ensure transparency and accountability regarding 6 the establishment, testing, implementation, evalua- 7 tion, and expansion of a model under subsections (b) 8 and (c) of section 1115A. Such public notice shall 9 describe and define the standards, criteria, and proc- 10 esses that the Secretary will use for selecting and 11 evaluating— 12 ‘‘(A) during initial stages of model develop- 13 ment; 14 ‘‘(B) prior to testing under section (b)(1); 15 ‘‘(C) prior to modification of non-contrac- 16 tual models under section (b)(3)(B); and 17 ‘‘(D) following evaluation of a model under 18 section (b)(4) and prior to rulemaking under 19 section (c). 20 Such notice shall explain the basis for the Sec- 21 retary’s determination that the conditions set forth 22 in subsection (c) have been met. Additionally, the 23 notice shall explain the basis fo [Text truncated for display. Full text available on Congress.gov.]