H.R. 10706 — Strengthening Innovation in Medicare and Medicaid Act

This section expresses the sense of Congress that the Center for Medicare and Medicaid Innovation should test payment and delivery models on a limited scale before any expansion, terminate models that fail to lower costs while maintaining patient outcomes, use mandatory models only when necessary and in limited scope, and that Congress may block models waiving Medicare provisions in ways that alter underlying statutes.

This section limits Phase I payment and service delivery model testing by the Center for Medicare and Medicaid Innovation. It caps each test at 5 years and the lesser of 10 percent of applicable individuals or 500,000 beneficiaries. Starting in FY2027, it allows no more than 6 new models per fiscal year and no more than 5 concurrent models with mandatory participation. It also requires the Secretary, within 60 days of enactment, to establish plans allowing hardship waivers for providers and monitoring real-time effects to mitigate adverse impacts on care access.

This section directs the Secretary of Health and Human Services to transmit proposals for testing, expansion, or modification of Center for Medicare and Medicaid Innovation models to the House Ways and Means and Energy and Commerce Committees and the Senate Finance and HELP Committees. The Secretary must implement the proposal if Congress does not enact a joint resolution of disapproval within 45 days under expedited procedures that limit committee consideration to 10 legislative days, floor debate to 2 hours, and bar amendments or recommitment.

This section requires the Secretary to provide advance public notice describing selection and evaluation standards, explain the basis for determinations under section 1115A(c), and allow a minimum 45-day public comment period before establishing, testing, modifying, or expanding Center for Medicare and Medicaid Innovation models, while considering stakeholder input. It also requires the CMI to consult relevant federal agencies and experts on the financial needs of safety net, rural, and critical access providers, including federally qualified health centers, and to use open door forums to incorporate external feedback into model development.

This section permits judicial review of actions under section 1115A demonstration projects when necessary to enforce statutory requirements or constitutional protections for program beneficiaries. It applies beginning on the date of enactment.

This section requires the Secretary to submit reports on the activities of the Center for Medicare and Medicaid Innovation biennially for years before 2027 and annually beginning in 2027, with each report for 2027 and subsequent years due by December 15.

This section requires the Secretary of Health and Human Services to consider ongoing payment and service delivery models when limiting testing of new models to specific geographic areas. It repeals the Medicare duplication prohibition that barred providers from participating in multiple alternative payment models. It also directs the Secretary to submit a report to Congress within 60 days assessing overlap under Medicare, with recommendations on multi-model participation, evaluation feasibility, and competing incentives.

This section expands Center for Medicare and Medicaid Innovation model eligibility to include those aimed solely at improving care quality, patient safety, and health outcomes for Medicare and Medicaid beneficiaries, with anticipated indirect savings over time. It adds evidence-based hospital care delivery practices and bundles that reduce readmissions or medical errors to the list of testable models. It requires disclosure of Chief Actuary assumptions and data to participating providers and in termination or expansion rules. It updates quality evaluations to measure patient-level outcomes, patient-centeredness, and unintended consequences using criteria appropriate to the conditions studied.

This section directs the Comptroller General to submit a report to Congress within 12 months of enactment analyzing the Center for Medicare and Medicaid Innovation’s efforts to attract, retain, and develop emerging experts; the impact of its existing authority on workforce shortages and gaps in priority areas; and the similarities and differences between its authority under section 1115A of the Social Security Act and the Secretary of Health and Human Services’ authority under section 402 of the Social Security Amendments of 1967.

This section applies amendments made by the Act to the testing, expansion, or modification of models on or after January 1, 2027.