- Bipartisan lawmakers introduced a bill Monday calling for increased accountability and oversight at the Center for Medicare and Medicaid Innovation, the HHS agency that tests new payment models for federally managed healthcare programs.
- The bill, called the Strengthening Innovation in Medicare and Medicaid Act, aims to create guardrails against policy changes made unilaterally by a single administration while increasing overall transparency and public participation on proposed models. It also seeks to reduce administrative burden on rural and underserved providers.
- If passed, the bill would require HHS to track how demonstration models impact patient access to care and potentially overhaul or eliminate those found to have adverse effects.
Founded under the Affordable Care Act, CMMI tests alternative payment models in a bid to push the industry toward value-based care. But those models and the decision-making behind them could change under the newly proposed legislation.
Lawmakers and some industry stakeholders have been concerned with the agency's broad reach and ability to test mandatory models for some time. For example, a handful of senators and representatives sent CMS oversight letters late last year protesting CMMI's radiation oncology advanced alternative payment model over concerns it would harm patient access to radiation treatment. CMS rolled back the model's implementation date following the backlash.
Along with its initial bipartisan backers, the bill received early praise from healthcare advocacy groups such as the Community Oncology Alliance, which called it "an important bill to ensure healthcare demonstration projects and models from the CMMI protect patient care and physician decision-making" in a statement Tuesday.
The bill would create an expedited congressional disapproval process for proposed models, along with new procedures to encourage public input in an effort to boost CMMI efficiency and transparency.
It would also require HHS Secretary Alex Azar to develop a plan to more effectively monitor the impact models have on their recipients and consult with experts on the healthcare and financial demands of minority, rural and underserved populations in particular.
Providers for rural populations can receive hardship exemptions from CMMI under the bill if they are subject to undue economic strain or if the agency's requirements caused vulnerable populations to lose access to specific providers.
"Encouraging innovation within our various health care safety net payment models is a fundamentally good thing," said Rep. John Shimkus, R-Ill., who introduced the bill alongside Reps. Terri Sewell, D-Ala., Adrian Smith, R-Neb., and Tony Cárdenas, D-Calif.
"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," Shimkus said.
This comes amid leadership changes at CMMI, with new head Brad Smith, an ex-Anthem executive, replacing Adam Boehler in January. A spokesperson with CMS, which oversees CMMI, said the agency declined to comment on pending legislation.
The bill was referred to the Committees on Energy and Commerce, Ways and Means, and Rules for forthcoming hearings.