U.S. Reps. Terri Sewell (D-AL), Adrian Smith (R-NE), Tony Cárdenas (D-CA) and John Shimkus (R-IL) introduced the Strengthening Innovation in Medicare and Medicaid Act (H.R. 5741) today, legislation that would increase transparency and accountability within the Center for Medicare and Medicaid Innovation (CMMI).
CMMI, also known as the “Innovation Center,” was created under the Affordable Care Act and is tasked with designing, testing and implementing new health care payment models that lower costs and improve outcomes in the Medicare, Medicaid and Children’s Health Insurance Programs (CHIP).
“The Innovation Center has been a critical component of Congress’ mission to deliver value-based health care focused on positive outcomes, especially in rural and underserved communities where health care providers struggle to take on the financial risks required to innovate patient care. It is essential that Congress ensures that CMMI functions as intended, to improve the quality and efficiency of care delivered, and incorporates greater opportunity for public input,” Rep. Sewell said. “The legislation we introduced today would safeguard the Center from implementing politically-driven or other policy changes made unilaterally by any administration that could be harmful to patients and providers.”
“Innovation is key in health care, and CMMI has an important role in improving health care delivery for the future. However, CMMI currently operates under a poorly defined framework which fails to provide for adequate oversight or transparency,” said Rep. Smith. “This bill would reduce uncertainty throughout the health care marketplace by providing for appropriate oversight of CMMI, while striving for the ultimate goals of lower health care costs and improved quality of care.”
“Supporting scientific research and medical breakthroughs are paramount to a strong healthcare system and for the general health and wellness of the public. CMMI plays a critical role in our healthcare system but oversight and accountability of CMMI are necessary for protecting patients, ensuring low costs and improving care. We need to support innovation and progress while also having sensible oversight and transparency,” said Rep. Cárdenas.
“Encouraging innovation within our various health care safety net payment models is a fundamentally good thing,” said Rep. Shimkus. “Done well, such innovation can lower costs and improve outcomes. But there is bipartisan agreement and recognition that, without additional guardrails and transparency, patient care could be compromised by even a well-intentioned experimental model. This legislation would help ensure the CMMI functions as Congress intended, with protections for both patients and providers.”
The current CMMI framework allows the executive branch to waive certain Medicare and Medicaid rules to test controversial approaches to deliver care without assurance that these changes will not have a negative effect on health care delivery outcomes. To address these concerns, the bill would establish guardrails, increase overall transparency and incorporates greater opportunity for public input.
Specifically, the Strengthening Innovation in Medicare and Medicaid Act:
• Helps ensure the CMMI model functions as Congress intended by:
o Requiring the Secretary of Health and Human Services to develop and implement a plan to monitor the effect of a model on applicable individuals, and mitigate any adverse impact, including reductions in care or reduced access to care; and
o Ensuring the plan assesses and tracks the impact of delivery and payment models on health disparities.
o Requiring the Secretary to mitigate any adverse impact that her or she determines could affect health care outcomes.
• Increases transparency when assessing CMMI rulemaking and payment models by:
o Creating an expedited Congressional disapproval process for models.
o Creating a new process for public input, including advance public notice and an opportunity for stakeholder input and public comments regarding the establishment, testing, implementation, evaluation, and expansion of a health care delivery model.
• And aims to reduce burden on rural health care providers while improving efficiency and overall outcomes by:
o Requiring CMMI to consult representatives of relevant federal agencies, clinical and analytical experts with expertise in medicine and health care management, specifically those with expertise in:
The health care needs of minority, rural and underserved populations, and
The financial needs of safety net, community based, rural and critical access providers, including federally qualified health centers.
o Providing hardship exemptions in the case that requirements by CMMI result in undue economic hardship for a provider or supplier, or loss of access to such provider for vulnerable populations.