I 

116TH CONGRESS 

2D SESSION H. R. 5741 

To amend title XI of the Social Security Act to clarify parameters for 

model testing and add accountability to model expansion under the Center for Medicare and Medicaid Innovation, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 3, 2020 

Ms. SEWELL of Alabama (for herself, Mr. SMITH of Nebraska, Mr. 

CA ́RDENAS, Mr. SHIMKUS, Mr. WENSTRUP, and Mr. SCHRADER) introduced the following bill; which was referred to the Committee on Energy 

and Commerce, and in addition to the Committees on Ways and Means, 

and Rules, for a period to be subsequently determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XI of the Social Security Act to clarify 

parameters for model testing and add accountability to 

model expansion under the Center for Medicare and 

Medicaid Innovation, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Strengthening Innova5 tion in Medicare and Medicaid Act’’. 


lotter on DSKBCFDHB2PROD with BILLS
2 

•HR 5741 IH

1 SEC. 2. DEFINING CMI MODEL TESTING PARAMETERS. 

2 (a) SCOPE AND DURATION OF MODELS.—Section 

3 1115A(a) of the Social Security Act (42 U.S.C. 1315a(a)) 

4 is amended by adding at the end the following new para5 graph: 

6 ‘‘(6) SCOPE AND DURATION OF MODELS TEST7 ED.—Beginning on or after the date of the enact8 ment of the Strengthening Innovation in Medicare 

9 and Medicaid Act, for purposes of testing new pay10 ment and service delivery models or expanding pay11 ment and service deliver models under this section, 

12 the Secretary shall limit testing of a model— 

13 ‘‘(A) to a period not to exceed 5 years; and 

14 ‘‘(B) no more applicable individuals than 

15 necessary to obtain a statistically valid sam16 ple.’’. 

17 (b) MODEL REQUIREMENT WAIVERS FOR HARD18 SHIP.—Section 1115A(a) of the Social Security Act (42 

19 U.S.C. 1315a(a)), as amended by subsection (a), is fur20 ther amended by adding at the end the following new para21 graph: 

22 ‘‘(7) HARDSHIP WAIVERS.—Not later than 60 

23 days after the date of the enactment of the 

24 Strengthening Innovation in Medicare and Medicaid 

25 Act, the Secretary shall develop and implement a 

26 plan to allow providers of services and suppliers to 


lotter on DSKBCFDHB2PROD with BILLS
3 

•HR 5741 IH

1 request a waiver from any requirement of a model 

2 if the Secretary determines that such requirement 

3 would result in undue economic hardship to such 

4 provider or supplier or loss of access to such pro5 vider or supplier for vulnerable populations.’’. 

6 (c) MONITORING IMPACT.—Section 1115A(a) of the 

7 Social Security Act (42 U.S.C. 1315a(a)), as amended by 

8 subsections (a) and (b), is further amended by adding at 

9 the end the following new paragraph: 

10 ‘‘(8) MONITORING IMPACT.—Not later than 60 

11 days after the date of the enactment of the 

12 Strengthening Innovation in Medicare and Medicaid 

13 Act, the Secretary shall develop and implement a 

14 plan to— 

15 ‘‘(A) monitor continuously and on a real16 time basis the effect of a model under sub17 section (b) on applicable individuals, and miti18 gate any adverse impact, such as inappropriate 

19 reductions in care or reduced access to care; 

20 ‘‘(B) assess and track the impact of deliv21 ery and payment models on health disparities, 

22 using existing measures such as the National 

23 Quality Forum Healthcare Disparities and Cul24 tural Competency Measure; and 


lotter on DSKBCFDHB2PROD with BILLS
4 

•HR 5741 IH

1 ‘‘(C) mitigate any adverse impact that the 

2 Secretary determines could affect beneficiary 

3 health.’’. 

4 SEC. 3. IMPLEMENTATION OF TESTING AND EXPANSION OF 

5 MODELS WITH CONGRESSIONAL INACTION. 

6 Section 1115A(d) of the Social Security Act (42 

7 U.S.C. 1315a(d)) is amended by adding at the end the 

8 following new paragraph: 

9 ‘‘(4) IMPLEMENTATION OF TESTING AND EX10 PANSION OF MODELS WITH CONGRESSIONAL INAC11 TION.— 

12 ‘‘(A) The Secretary shall transmit a pro13 posal for the testing, expansion, or modification 

14 of a model under subsection (b) or (c), includ15 ing a proposed effective date and a summary of 

16 the determinations and certification made under 

17 paragraphs (1) through (3) of subsection (c), if 

18 applicable, to the Committee on Ways and 

19 Means and the Committee on Energy and Com20 merce of the House of Representatives and to 

21 the Committee on Finance and the Committee 

22 on Health, Education, Labor, and Pensions of 

23 the Senate. 

24 ‘‘(B) The testing, expansion, or modifica25 tion of model proposed in a report submitted 


lotter on DSKBCFDHB2PROD with BILLS
5 

•HR 5741 IH

1 under subparagraph (A) shall be carried out by 

2 the Secretary if the Congress does not, within 

3 45 days of receiving a report transmitted from 

4 the Secretary detailing the proposed testing or 

5 expansion including the proposed effective date 

6 for such testing or expansion and a summary of 

7 the determinations and certification made under 

8 paragraphs (1) through (3), pass a joint resolu9 tion disapproving of the proposed testing or ex10 pansion in accordance with the following proce11 dure: 

12 ‘‘(i) The succeeding subparagraphs of 

13 this paragraph are enacted by Congress as 

14 an exercise of the rulemaking power of the 

15 Senate and the House of Representatives, 

16 respectively, and as such they shall be 

17 deemed a part of the rules of each House, 

18 respectively, but applicable only with the 

19 respect to the procedure to be followed in 

20 that House in the case of resolutions de21 scribed in subparagraph (B). They shall 

22 supersede other rules only to the extent 

23 that they are inconsistent therewith. They 

24 are enacted with full recognition of the 

25 constitutional right of either House to 


lotter on DSKBCFDHB2PROD with BILLS
6 

•HR 5741 IH

1 change the rules (so far as relating to the 

2 procedure of that House) at any time, in 

3 the same manner and to the same extent 

4 as in the case of any ruse of that House. 

5 ‘‘(ii) For the purpose of the suc6 ceeding provisions of this subparagraph, 

7 ‘‘resolution’’ means only a joint resolution, 

8 the matter after the resolving clause of 

9 which is as follows: ‘That Congress dis10 approves the model expansion requested 

11 pursuant to section 1115A(c) of the Social 

12 Security Act transmitted by the Secretary 

13 on lllll, and such an expansion 

14 shall not proceed.’, the blank space therein 

15 being filled with the date on which the Sec16 retary’s message proposing such expansion 

17 was delivered. 

18 ‘‘(iii) Upon receipt of a report sub19 mitted to Congress under subparagraph 

20 (c)(4), each House shall provide copies of 

21 the report to the chairman and ranking 

22 member of the Committee on Ways and 

23 Means and the Committee on Energy and 

24 Commerce of the House of Representatives 

25 and to the Committee on Finance and the 


lotter on DSKBCFDHB2PROD with BILLS
7 

•HR 5741 IH

1 Committee on Health, Education, Labor, 

2 and Pensions of the Senate. 

3 ‘‘(iv) A resolution shall be referred to 

4 the Committee on Ways and Means and 

5 the Committee on Energy and Commerce 

6 of the House of Representatives and to the 

7 Committee on Finance and the Committee 

8 on Health, Education, Labor, and Pen9 sions of the Senate. 

10 ‘‘(v) If a committee to which has been 

11 referred a resolution has not reported it 

12 before the expiration of 10 legislative days 

13 after its introduction, it shall then (but not 

14 before) be in order to move to discharge 

15 the committee from further consideration 

16 of that resolution, or to discharge the com17 mittee from further consideration of any 

18 other resolution with respect to the pro19 posed expansion which has been referred to 

20 the committee. The motion to discharge 

21 may be made only by a person favoring the 

22 resolution, shall be highly privileged (ex23 cept that it may not be made after the 

24 committee has reported a resolution with 

25 respect to the same proposed expansion), 


lotter on DSKBCFDHB2PROD with BILLS
8 

•HR 5741 IH

1 and debate thereon shall be limited to not 

2 more than 1 hour, to be divided equally be3 tween those favoring and those opposing 

4 the resolution. An amendment to the mo5 tion is not in order, and it is not in order 

6 to move to reconsider the vote by which 

7 the motion is agreed to or disagreed to. If 

8 the motion to discharge is agreed to or dis9 agreed to, the motion may not be renewed, 

10 nor may another motion to discharge the 

11 committee be made with respect to any 

12 other resolution with respect to the same 

13 proposed expansion. 

14 ‘‘(vi) When the committee has re15 ported, or has been discharged from fur16 ther consideration of a resolution, it is at 

17 any time thereafter in order (even though 

18 a previous motion to the same effect has 

19 been disagreed to) to move to proceed to 

20 the consideration of the resolution. The 

21 motion is highly privileged and is not de22 batable. An amendment to the motion is 

23 not in order, and it is not in order to move 

24 to reconsider the vote by which the motion 

25 is agreed to or disagreed to. Debate on the 


lotter on DSKBCFDHB2PROD with BILLS
9 

•HR 5741 IH

1 resolution shall be limited to not more than 

2 2 hours, which shall be divided equally be3 tween those favoring and those opposing 

4 the resolution. A motion further to limit 

5 debate is not debatable. An amendment to, 

6 or motion to recommit, the resolution is 

7 not in order, and it is not in order to move 

8 to reconsider the vote by which the resolu9 tion is agreed to or disagreed to. 

10 ‘‘(vii) Motions to postpone, made with 

11 respect to the discharge from committee, 

12 or the consideration of, a resolution and 

13 motions to proceed to the consideration of 

14 other business shall be decided without de15 bate. Appeals from the decision of the 

16 Chair relating to the application of the 

17 rules of the Senate or the House of Rep18 resentatives, as the case may be, to the 

19 procedure relating to a resolution shall be 

20 decided without debate. 

21 ‘‘(viii) COORDINATION WITH ACTION

22 BY OTHER HOUSE.—If, before the passage 

23 by one House of a joint resolution of that 

24 House, that House receives from the other 


lotter on DSKBCFDHB2PROD with BILLS
10 

•HR 5741 IH

1 House a joint resolution, then the following 

2 procedures shall apply: 

3 ‘‘(I) The joint resolution of the 

4 other House shall not be referred to a 

5 committee. 

6 ‘‘(II) With respect to a joint res7 olution of the House receiving the res8 olution, the procedure in that House 

9 shall be the same as if no joint resolu10 tion had been received from the other 

11 House, the vote on passage shall be 

12 on the joint resolution of the other 

13 House. 

14 ‘‘(ix) If one House fails to introduce 

15 or consider a joint resolution under this 

16 section, the joint resolution of the other 

17 House shall be entitled to expedited floor 

18 procedures under this section. 

19 ‘‘(x) If, following passage of the joint 

20 resolution in the Senate, the Senate then 

21 receives the companion measure from the 

22 House of Representatives, the companion 

23 measure shall not be debatable. 

24 ‘‘(xi) If Congress passes a joint reso25 lution, the period beginning on the date 


lotter on DSKBCFDHB2PROD with BILLS
11 

•HR 5741 IH

1 the President is presented with the joint 

2 resolution and ending on the date the 

3 President takes action with respect to the 

4 joint resolution shall be disregarded in 

5 computing the 45-calendar day period de6 scribed in subparagraph (c)(4). 

7 ‘‘(xii) If the President vetoes the joint 

8 resolution— 

9 ‘‘(I) the period beginning on the 

10 date the President vetoes the joint 

11 resolution and ending on the date the 

12 Congress receives the veto message 

13 with respect to the joint resolution 

14 shall be disregarded in computing the 

15 45-calendar day period described in 

16 subparagraph (c)(4), and 

17 ‘‘(II) debate on a veto message in 

18 the Senate under this section shall be 

19 1 hour equally divided between the 

20 majority and minority leaders or their 

21 designees.’’. 

22 SEC. 4. PUBLIC INPUT AND CONSULTATION. 

23 Section 1115A(d) of the Social Security Act (42 

24 U.S.C. 1315a(d)), as amended by section 3, is further 


lotter on DSKBCFDHB2PROD with BILLS
12 

•HR 5741 IH

1 amended by adding at the end of the following new para2 graphs: 

3 ‘‘(6) PUBLIC INPUT.—The Secretary shall use a 

4 process involving advance public notice and an op5 portunity for stakeholder input and public comments 

6 to ensure transparency and accountability regarding 

7 the establishment, testing, implementation, evalua8 tion, and expansion of a model under subsections (b) 

9 and (c) of section 1115A. Such public notice shall 

10 describe and define the standards, criteria, and proc11 esses that the Secretary will use for selecting and 

12 evaluating— 

13 ‘‘(A) during initial stages of model develop14 ment; 

15 ‘‘(B) prior to testing under section (b)(1); 

16 ‘‘(C) prior to modification of non-contrac17 tual models under section (b)(3)(B); and 

18 ‘‘(D) following evaluation of a model under 

19 section (b)(4) and prior to rulemaking under 

20 section (c). 

21 Such notice shall explain the basis for the Sec22 retary’s determination that the conditions set forth 

23 in subsection (c) have been met. Additionally, the 

24 notice shall explain the basis for selection and the 

25 standards established by the Secretary under the 


lotter on DSKBCFDHB2PROD with BILLS
13 

•HR 5741 IH

1 regulations issued under paragraph (1), and any ad2 ditional factors that will be used to test the model’s 

3 impact on quality of care, patient-centeredness, and 

4 innovation. The notice shall provide a minimum 45- 

5 day period for public comment. The Secretary shall 

6 take stakeholder comments into consideration when 

7 determining whether or how to refine the model or 

8 whether to proceed with testing under subsection 

9 (b)(1). 

10 ‘‘(7) CONSULTATION.—In carrying out the du11 ties under this section, the CMI shall consult rep12 resentatives of relevant Federal agencies, and clin13 ical and analytical experts with expertise in medicine 

14 and health care management, specifically such ex15 perts with expertise in— 

16 ‘‘(A) the health care needs of minority, 

17 rural, and underserved populations; and 

18 ‘‘(B) the financial needs of safety net, 

19 community based, rural, and critical access pro20 viders, including federally qualified health cen21 ters. 

22 The CMI shall use open door forums or other mech23 anisms to seek external feedback from interested 

24 parties and incorporate that feedback into the devel25 opment of models.’’. 


lotter on DSKBCFDHB2PROD with BILLS
14 

•HR 5741 IH

1 SEC. 5. REESTABLISHING JUDICIAL REVIEW. 

2 Section 1115A(d)(2) of the Social Security Act (42 

3 U.S.C. 1315a(d)(2)) is amended— 

4 (1) in the matter preceding subparagraph (A), 

5 by inserting after ‘‘or otherwise’’ the following: ‘‘(ex6 cept as may be necessary to enforce requirements of 

7 this section or other laws or constitutional provisions 

8 intended to protect beneficiaries of affected pro9 grams)’’; 

10 (2) by striking subparagraph (C); 

11 (3) in subparagraph (D), by adding at the end 

12 ‘‘; and’’; 

13 (4) by redesignating subparagraph (D) as sub14 paragraph (C); 

15 (5) in subparagraph (E), at the end, by striking 

16 ‘‘; and’’ and inserting a period; 

17 (6) by redesignating subparagraph (E) as sub18 paragraph (D); and 

19 (7) by striking subparagraph (F). 

20 SEC. 6. REVISION OF REPORTING REQUIREMENT. 

21 Section 1115A(g) of the Social Security Act (42 

22 U.S.C. 1315a(g)) is amended— 

23 (1) by striking ‘‘and not less than once every 

24 other year thereafter’’ and inserting ‘‘and, for years 

25 before 2020, not less than once biennially (and, for 


lotter on DSKBCFDHB2PROD with BILLS
15 

•HR 5741 IH

1 years beginning with 2020, not less than annually) 

2 thereafter’’; and 

3 (2) by adding at the end the following new sen4 tence: ‘‘With respect to 2020 and each subsequent 

5 year, the Secretary shall submit each such report by 

6 not later than December 15 of such year.’’. 

7 SEC. 7. ADDRESSING OVERLAP IN VALUE BASED CARE PRO8 GRAMS. 

9 (a) IN GENERAL.— 

10 (1) CMI.—Section 1115A(a)(5) of the Social 

11 Security Act (42 U.S.C. 1315a(a)(5)) is amended by 

12 adding at the end the following new sentence: ‘‘In 

13 establishing such limits, the Secretary shall take into 

14 account payment and service delivery models in 

15 progress in such geographic areas.’’. 

16 (2) REPEAL OF MEDICARE DUPLICATION PRO17 HIBITION.—Section 1899(b)(4) of the Social Secu18 rity Act (42 U.S.C. 1395jjj(b)) is amended by strik19 ing subparagraph (A). 

20 (b) REPORT.—Not later than 60 days after the date 

21 of the enactment of this Act, the Secretary of Health and 

22 Human Services shall conduct an assessment and submit 

23 to Congress a report on alternative payment model overlap 

24 under the Medicare program under title XVIII of the SoVerDate Sep 11 2014 19:56 Feb 04, 2020 Jkt 099200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H5741.IH H5741

lotter on DSKBCFDHB2PROD with BILLS
16 

•HR 5741 IH

1 cial Security Act. Such report shall include a description 

2 of and recommendations relating to— 

3 (1) any issues regarding the existence of mul4 tiple alternative payment model participation oppor5 tunities for health care providers; and 

6 (2) obstacles created by competing incentives 

7 with respect to alternative payment models. 

8 SEC. 8. GAO REPORT. 

9 Not later than 12 months after the date of enactment 

10 of this Act, the Comptroller General of the United States 

11 shall submit to Congress a report on the efforts of the 

12 Center for Medicare and Medicaid Innovation to attract, 

13 retain, and develop emerging experts, including under-rep14 resented individuals in medicine, such as women, racial 

15 and ethnic minorities, and other groups. Such report shall 

16 include an analysis of the impact of the existing authority 

17 provided to the Center for Medicare and Medicaid Innova18 tion to address workforce shortages and gaps in priority 

19 areas. 

20 SEC. 9. MODELS SPECIFICALLY TO IMPROVE QUALITY OF 

21 CARE. 

22 (a) CLARIFICATION OF MODEL ELIGIBILITY.—Sec23 tion 1115A of the Social Security Act (42 U.S.C. 1315a) 

24 is amended— 

25 (1) in subsection (a)(1)— 


lotter on DSKBCFDHB2PROD with BILLS
17 

•HR 5741 IH

1 (A) by striking ‘‘while preserving or en2 hancing the quality of care’’ and inserting ‘‘or 

3 to enhance quality of care’’; and 

4 (B) by striking ‘‘also’’ before ‘‘improve’’; 

5 and 

6 (2) in subsection (b)(2)(A) by inserting after 

7 the second sentence the following new sentence: 

8 ‘‘The Secretary may also focus on models solely 

9 aimed at practices to significantly improve the care 

10 and health outcomes of individuals receiving benefits 

11 under the applicable title in anticipation that quality 

12 of care benefits and potential direct or indirect sav13 ings will accrue to the Medicare or Medicaid pro14 gram.’’. 

15 (b) ADDITIONAL OPPORTUNITY.—Section 

16 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 

17 1315a(b)(2)(B)) is amended by adding at the end the fol18 lowing new clause: 

19 ‘‘(xxviii) Implementing newly recog20 nized and evidence-based, professionally 

21 supported care delivery practices and bun22 dles to improve the efficient and effective 

23 delivery of hospital-based care and lead to 

24 enhanced patient outcomes, reductions in 


lotter on DSKBCFDHB2PROD with BILLS
18 

•HR 5741 IH

1 readmissions, or avoidance of costly med2 ical errors or complications.’’. 

3 (c) INCLUSION OF INDIRECT SAVINGS.—Section 

4 1115A(b)(3)(A) of the Social Security Act (42 U.S.C. 

5 1315a(b)(3)(A)) is amended by inserting at the end ‘‘or 

6 that savings cannot be made indirectly over time when 

7 testing quality of care delivery models.’’. 

8 (d) EVALUATING QUALITY OF CARE.—Section 

9 1115A(b)(4) of the Social Security Act (42 U.S.C. 

10 1315a(b)(4)) is amended— 

11 (1) in subparagraph (A), by amending clause (i) 

12 to read as follows: 

13 ‘‘(i) the quality of care furnished 

14 under the model, including the measure15 ment of patient-level outcomes, patient16 centeredness, and any unintended con17 sequences, such as access to services, using 

18 criteria determined appropriate by the Sec19 retary for each model; and’’; and 

20 (2) in subparagraph (C), by striking ‘‘and’’ be21 fore ‘‘patient-centered care’’ and inserting ‘‘, are ap22 propriate to issues of quality outcomes related to the 

23 medical conditions under study, and are’’. 


lotter on DSKBCFDHB2PROD with BILLS
19 

•HR 5741 IH

1 SEC. 10. EFFECTIVE DATE. 

2 Except as otherwise provided in the previous sections 

3 of this Act (or the amendments made by such sections), 

4 such amendments shall apply with respect to the testing, 

5 expansion, or modification of models on or after January 

6 1, 2020. 

Æ 


lotter on DSKBCFDHB2PROD with BILLS