Innovation Center would check payment models for unfair health gaps

The health secretary would favor models that promote health equity and would use specified consultation and selection checks. These rules cover models the Medicare and Medicaid Innovation Center considers for testing. Before selecting a model, the secretary must consult the Centers for Medicare & Medicaid Services Office of Minority Health, the Office of Rural Health Policy, and the Office on Women’s Health. That consultation must ensure models address health gaps and living conditions that affect health when appropriate for the people they would serve. During broader consultation, officials would include those offices and experts on the causes of health gaps and living conditions affecting health. Selection reviews would examine provider access and possible reductions in minority and rural health gaps.

Officials would consider health equity and worsening inequities when selecting, evaluating, changing, ending, or expanding tested models. These standards cover payment and care models tested by the Medicare and Medicaid Innovation Center. For models whose testing begins on or after January 1, 2027, selection would require addressing health equity and improving beneficiaries’ access to care. Evaluations would measure how much these models improve health equity. From January 1, 2027, the two basic tests for expanding a model would also ask whether it increases health inequities or improves health equity. With no delayed start stated, change-or-end decisions would consider health equity or increased inequities. A separate expansion check would consider disparities for low-income, minority, or rural beneficiaries and whether expansion improves equity. Specified selection, evaluation, and expansion standards apply from January 1, 2027. The change-or-end criteria and separate expansion consideration have no stated delayed start.

The Innovation Center would have to begin testing a regional model focused on living conditions that affect health. The health secretary would choose the region where the model is tested. The model would have to test every payment and care approach listed in the bill. One approach would gather useful data aimed at higher costs among beneficiaries diagnosed with behavioral conditions. Other approaches would target health conditions among people entitled to or enrolled in Medicare who are also enrolled in Medicaid, and among a group called applicable individuals, to increase capacity in underserved areas. Another approach would focus on pregnant and postpartum women eligible for Medicaid through one year after delivery. Testing of this model would have to begin no later than December 31, 2027.

Each Innovation Center report submitted after enactment would have to describe efforts to address health gaps and their results. These reports cover payment models the Innovation Center selects for testing. Reports would have to identify interventions that address living conditions affecting health, health gaps, or health equity. Reports would have to estimate federal savings from reducing rural or minority health gaps, improving health equity, or addressing living conditions that affect health. Reports would have to assess how well interventions reduce harmful health outcomes and higher costs tied to those living conditions, and cover any other areas the secretary finds appropriate. The requirements would apply to reports submitted after enactment.