Bill would limit and oversee Medicare and Medicaid test programs

Federal health officials would limit the size, length, and number of first-phase tests, provide a hardship-waiver process, and monitor their effects. Each test could cover no more than 10% of the affected people or 500,000 beneficiaries, whichever is lower. The center could start six per year and run no more than five mandatory first-phase tests at once. A provider could request a waiver when a model requirement would cause undue financial hardship or reduce vulnerable groups’ access to care. Officials would continuously monitor effects on participants and act to reduce harmful effects, including reduced access or inappropriate cuts in care. The size and length limits would begin upon enactment. The yearly cap would start in fiscal year 2027, and the waiver and monitoring plans would be due within 60 days after enactment.

The Health and Human Services Secretary would send model plans to Congress and give the public advance notice and an opportunity to comment. The process would cover proposals to test, expand, or modify Medicare and Medicaid payment and care programs. A plan would proceed if Congress did not pass a joint resolution against it within the review period. The notice would explain how officials select and evaluate the model, and officials would consider comments when deciding whether to refine or test it. The center would also seek feedback from relevant agencies, health experts, and providers serving rural, low-income, and other underserved communities. The congressional process would apply upon enactment. Time used for specified presidential action or delivery of a veto message would not count toward the 45-day review period.

Courts could hear additional challenges involving the federal health care test programs. The provisions concern beneficiaries of affected Medicare, Medicaid, and related federal health programs. Review would be available when needed to enforce this section or other legal or constitutional protections for beneficiaries. The text would also remove listed review barriers involving model elements, parameters, scope, duration, and decisions to expand models. These judicial-review provisions would apply beginning on the date of enactment.

Federal health officials could test programs focused on better care and would share information behind key financial certifications with participating providers. The provisions cover Medicare and Medicaid test programs, including programs aimed only at improving care when savings may develop indirectly over time. A listed option for hospital care would require newly recognized, evidence-based, and professionally supported practices. Evaluations would examine patient outcomes, how well care reflects patient needs, and unintended effects such as reduced access. Unless another section provides otherwise, these provisions would apply to models tested, expanded, or modified on or after January 1, 2027.

HHS would address overlapping payment programs, while HHS and Congress’s audit agency would provide additional oversight reports. The text would strike a Medicare rule barring certain duplication and require studies of overlapping value-based payment programs and the innovation center’s workforce and authority. When setting geographic limits, the Secretary would account for other payment and care programs already operating in the area. The HHS study would examine participation in multiple payment programs, whether those programs can still be evaluated, and problems caused by competing incentives. The Government Accountability Office would examine the center’s workforce expertise and compare its legal authority with another federal demonstration authority. Beginning in 2027, center reports would be due annually by December 15. The HHS overlap report would be due within 60 days after enactment, and the federal audit report within 12 months.