SEC. 2. SENSE OF CONGRESS. 
It is the sense of Congress that: 
(1) The Center for Medicare and Medicaid In-
novation (CMI) represents a valuable tool for testing 
innovative health care payment and service delivery 
models which can improve the coordination, quality, 
and efficiency of health care services. 
(2) The model testing process is intended to 
test concepts on a limited scale first in Phase I, then 
assess initial results, and, if results merit, expand 
the model to a larger test in Phase II to confirm the 
initial results. 
(3) Starting model testing on a limited scale, 
assessing results, and then expanding the model to 
confirm initial results protects the integrity of the 
Medicare program by minimizing unintentional 
losses or negative impacts to the patients or pro-
viders participating in Phase I model testing. 
(4) CMI should focus its attention on models 
most likely to succeed and should continually assess 
models and terminate those which are not gener-
ating results in keeping with its purpose—lowering 
costs while maintaining or preserving patient out-
comes. 
(5) Mandatory models may be necessary to test 
certain payment models but should be used judi-
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ciously and be as limited in scope as possible to min-
imize accidental adverse impacts. 
(6) As CMI may waive certain provisions of 
Medicare regulations, Congress may block models 
which functionally alter or change the underlying ex-
isting statutes. 
SEC. 3. DEFINING CMI MODEL TESTING PARAMETERS. 
(a) SCOPE AND DURATION OF MODELS.—Section 
1115A(a) of the Social Security Act (42 U.S.C. 1315a(a)) 
is amended by adding at the end the following new para-
graph: 
‘‘(6) SCOPE AND DURATION OF MODELS TEST-
ED.—beginning on or after the date of the enact-
ment of the Strengthening Innovation In Medicare 
and Medicaid Act, for purposes of testing new pay-
ment and service delivery models, the Secretary shall 
limit testing of a Phase 1 model to— 
‘‘(A) a period not to exceed 5 years; and 
‘‘(B) to the lesser of ten percent of appli-
cable individuals or 500,000 beneficiaries.’’. 
(b) CAP ON PHASE 1 MODEL TESTING.—Section 
1115A(a) of the Social Security Act (42 U.S.C. 1315a(a)), 
as amended by subsection (a), is further amended by add-
ing at the end the following new paragraph: 
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‘‘(7) PHASE
MODEL
LIMITATIONS.—During 
each fiscal year starting with Fiscal Year 2023, CMI 
shall initiate Phase 1 testing of no more than six 
new models each fiscal year. Additionally, CMI shall 
not concurrently test more than five Phase 1 models 
which involve mandatory, involuntary, or compulsory 
participation.’’. 
(c) REQUIRED WAIVERS FOR HARDSHIP.—Section 
1115A(a) of the Social Security Act (42 U.S.C. 1315a(a)), 
as amended by subsection (a), is further amended by add-
ing at the end the following new paragraph: 
‘‘(8) HARDSHIP WAIVERS.—Not later than 60 
days after the enactment of the Strengthening Inno-
vation in Medicare and Medicaid Act, the Secretary 
shall develop and implement a plan to allow applica-
ble providers of services or supplies to request a 
waiver from any requirement of a model if the Sec-
retary determines that such requirement would re-
sult in undue economic hardship to such provider or 
supplier or loss of access to such healthcare services 
or supplies for vulnerable populations.’’. 
(d) MONITORING IMPACT.—Section 1115A(a) of the 
Social Security Act (42 U.S.C. 1315a(a)), as amended by 
subsections (a) and (b), is further amended by adding at 
the end the following new paragraph: 
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‘‘(9) MONITORING IMPACT.—Not later than 60 
days after the enactment of the Strengthening Inno-
vation in Medicare and Medicaid Act, the Secretary 
shall develop and implement a plan to— 
‘‘(A) monitor continuously and on a real- 
time basis the effect of a model under sub-
section (b) on applicable individuals, and miti-
gate any adverse impact, such as inappropriate 
reductions in care or reduced access to care; 
‘‘(B) assess and track the impact of deliv-
ery and payment models on health disparities, 
using existing measures such as, but not limited 
to, the National Quality Forum Healthcare Dis-
parities and Cultural Competency Measures; 
and 
‘‘(C) mitigate any adverse impact that the 
Secretary determines could affect beneficiary 
health.’’. 
SEC. 4. IMPLEMENTATION OF TESTING AND EXPANSION OF 
MODELS WITH CONGRESSIONAL INACTION. 
Section 1115A(d) of the Social Security Act (42 
U.S.C. 1315a(d)) is amended by adding at the end the 
following new paragraph: 
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‘‘(4) IMPLEMENTATION OF TESTING AND EX-
PANSION OF MODELS WITH CONGRESSIONAL INAC-
TION.— 
‘‘(A) The Secretary shall transmit a pro-
posal for the testing, expansion, or modification 
of a model under subsections (b) and (c), in-
cluding a proposed effective date and a sum-
mary of the determinations and certification 
made under paragraphs (1) through (3) of sub-
section (c), if applicable, to the Committee on 
Ways and Means and the Committee on Energy 
and Commerce of the House of Representatives 
and to the Committee on Finance and the Com-
mittee on Health, Education, Labor, and Pen-
sions of the Senate. 
‘‘(B) The testing, expansion, or modifica-
tion of a model proposed in a report submitted 
under subparagraph (A) shall be carried out by 
the Secretary if Congress does not, within 45 
days of receiving such report, pass a joint reso-
lution disapproving of the proposed testing or 
expansion in accordance with the following pro-
cedure: 
‘‘(i) The succeeding subparagraphs of 
this paragraph are enacted by Congress as 
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an exercise of the rulemaking power of the 
Senate and the House of Representatives, 
respectively, and as such they shall be 
deemed a part of the rules of each House, 
respectively, but applicable only with the 
respect to the procedure to be followed in 
that House in the case of resolutions de-
scribed in subparagraph (B). They shall 
supersede other rules only to the extent 
that they are inconsistent therewith. They 
are enacted with full recognition of the 
constitutional right of either House to 
change the rules (so far as relating to the 
procedure of that House) at any time, in 
the same manner and to the same extent 
as in the case of any ruse of that House. 
‘‘(ii) For the purpose of the suc-
ceeding paragraphs of this subsection, ‘res-
olution’ means only a joint resolution, the 
matter after the resolving clause of which 
is as follows: ‘That Congress disapproves 
the model expansion requested pursuant to 
section 1115A(c) of the Social Security Act 
transmitted 
by 
the 
Secretary 
on 
lllll, and such an expansion shall 
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not proceed.’, the blank space therein 
being filled with the date on which the Sec-
retary’s message proposing such expansion 
was delivered. 
‘‘(iii) Upon receipt of a report sub-
mitted to Congress under subparagraph 
(c)(4), each House shall provide copies of 
the report to the chairman and ranking 
member of the Committee on Ways and 
Means and the Committee on Energy and 
Commerce of the House of Representatives 
and to the Committee on Finance and the 
Committee on Health, Education, Labor, 
and Pensions of the Senate. 
‘‘(iv) A resolution shall be referred to 
the Committee on Ways and Means and 
the Committee on Energy and Commerce 
of the House of Representatives and to the 
Committee on Finance and the Committee 
on Health, Education, Labor, and Pen-
sions of the Senate. 
‘‘(v) If a committee to which has been 
referred a resolution has not reported it 
before the expiration of 10 legislative days 
after its introduction, it shall then (but not 
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before) be in order to move to discharge 
the committee from further consideration 
of that resolution, or to discharge the com-
mittee from further consideration of any 
other resolution with respect to the pro-
posed expansion which has been referred to 
the committee. The motion to discharge 
may be made only by a person favoring the 
resolution, shall be highly privileged (ex-
cept that it may not be made after the 
committee has reported a resolution with 
respect to the same proposed expansion), 
and debate thereon shall be limited to not 
more than 1 hour, to be divided equally be-
tween those favoring and those opposing 
the resolution. An amendment to the mo-
tion is not in order, and it is not in order 
to move to reconsider the vote by which 
the motion is agreed to or disagreed to. If 
the motion to discharge is agreed to or dis-
agreed to, the motion may not be renewed, 
nor may another motion to discharge the 
committee be made with respect to any 
other resolution with respect to the same 
proposed expansion. 
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‘‘(vi) When the committee has re-
ported, or has been discharged from fur-
ther consideration of a resolution, it is at 
any time thereafter in order (even though 
a previous motion to the same effect has 
been disagreed to) to move to proceed to 
the consideration of the resolution. The 
motion is highly privileged and is not de-
batable. An amendment to the motion is 
not in order, and it is not in order to move 
to reconsider the vote by which the motion 
is agreed to or disagreed to. Debate on the 
resolution shall be limited to not more than 
2 hours, which shall be divided equally be-
tween those favoring and those opposing 
the resolution. A motion further to limit 
debate is not debatable. An amendment to, 
or motion to recommit, the resolution is 
not in order, and it is not in order to move 
to reconsider the vote by which the resolu-
tion is agreed to or disagreed to. 
‘‘(vii) Motions to postpone, made with 
respect to the discharge from committee, 
or the consideration of, a resolution and 
motions to proceed to the consideration of 
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other business shall be decided without de-
bate. Appeals from the decision of the 
Chair relating to the application of the 
rules of the Senate or the House of Rep-
resentatives, as the case may be, to the 
procedure relating to a resolution shall be 
decided without debate. 
‘‘(viii) COORDINATION
WITH
ACTION 
BY
THE
OTHER
HOUSE.—If, before the 
passage by one House of a joint resolution 
of that House, that House receives from 
the other House a joint resolution, then 
the following procedures shall apply: 
‘‘(I) The joint resolution of the 
other House shall not be referred to a 
committee. 
‘‘(II) With respect to a joint res-
olution of the House receiving the res-
olution, the procedure in that House 
shall be the same as if no joint resolu-
tion had been received from the other 
House; but the vote on passage shall 
be on the joint resolution of the other 
House. 
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‘‘(ix) If one House fails to introduce 
or consider a joint resolution under this 
section, the joint resolution of the other 
House shall be entitled to expedited floor 
procedures under this section. 
‘‘(x) If, following passage of the joint 
resolution in the Senate, the Senate then 
receives the companion measure from the 
House of Representatives, the companion 
measure shall not be debatable. 
‘‘(xi) If Congress passes a joint reso-
lution, the period beginning on the date 
the President is presented with the joint 
resolution and ending on the date the 
President takes action with respect to the 
joint resolution shall be disregarded in 
computing the 45-calendar day period de-
scribed in subsection (c)(4). 
‘‘(xii) If the President vetoes the joint 
resolution— 
‘‘(I) the period beginning on the 
date the President vetoes the joint 
resolution and ending on the date the 
Congress receives the veto message 
with respect to the joint resolution 
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shall be disregarded in computing the 
45-calendar day period described in 
subsection (c)(4); and 
‘‘(II) debate on a veto message in 
the Senate under this section shall be 
1 hour equally divided between the 
majority and minority leaders or their 
designees.’’. 
SEC. 5. PUBLIC INPUT. 
Section 115A(d) of the Social Security Act (42 
U.S.C. 1315a(d)) is amended by section 3, is further 
amended by adding at the end of the following new para-
graphs: 
‘‘(5) PUBLIC INPUT.—The Secretary shall use a 
process involving advance public notice and an op-
portunity for stakeholder input and public comments 
to ensure transparency and accountability regarding 
the establishment, testing, implementation, evalua-
tion, and expansion of a model under section 
1115A(b) and (c). Such public notice shall describe 
and define the standards, criteria, and processes 
that the Secretary will use for selecting and evalu-
ating— 
‘‘(A) during initial stages of model develop-
ment; 
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‘‘(B) prior to testing under subsection 
(b)(1); 
‘‘(C) prior to modification of non-contrac-
tual models under subsection (b)(3)(B); and 
‘‘(D) following evaluation of a model under 
subsection (b)(4) and prior to rulemaking under 
subsection (c). 
Such notice shall explain the basis for the Sec-
retary’s determination that the conditions set forth 
in section 115A(c) of the Social Security Act (42 
U.S.C. 1315a(c)) have been met. Additionally, the 
notice shall explain the basis for selection and the 
standards established by the Secretary under the 
regulations issued under paragraph (1), and any ad-
ditional factors that will be used to test the model’s 
impact on quality of care, patient-centeredness, and 
innovation. The notice shall provide a minimum 45- 
day period for public comment. The Secretary shall 
take stakeholder comments into consideration when 
determining whether or how to refine the model or 
whether to proceed with testing under subsection 
(b)(1). 
‘‘(6) CONSULTATION.—In carrying out the du-
ties under this subsection, the CMI shall consult 
representatives of relevant Federal agencies, and 
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clinical and analytical experts with expertise in medi-
cine and health care management, specifically such 
experts with expertise in— 
‘‘(A) the health care needs of minority, 
rural and underserved populations; and 
‘‘(B) the financial needs of safety net, 
community-based, rural, and critical access pro-
viders, including federally qualified health cen-
ters. 
The CMI shall use open door forums or other mech-
anisms to seek external feedback from interested 
parties and incorporate that feedback into the devel-
opment of models.’’. 
SEC. 6. REESTABLISHING JUDICIAL REVIEW. 
Section 1115A(g) of the Social Security Act (42 
U.S.C. 1315a(g)) is amended— 
(1) in the matter preceding subparagraph (A) 
by inserting after ‘‘or otherwise’’ the following: ‘‘(ex-
cept as may be necessary to enforce requirements of 
this section or other laws or constitutional provisions 
intended to protect beneficiaries of affected pro-
grams)’’; 
(2) by striking subparagraph (C); 
(3) in subparagraph (D), by adding at the end 
‘‘; and’’; 
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(4) by redesignating subparagraph (D) as sub-
paragraph (C); 
(5) in subparagraph (E), at the end, by striking 
‘‘; and’’; 
(6) by redesignating subparagraph (E) as sub-
paragraph (D); and 
(7) by striking subparagraph (F). 
SEC. 7. REVISION OF REPORTING REQUIREMENT. 
Section 1115A(g) of the Social Security Act (42 
U.S.C. 1315a(g)) is amended— 
(1) by striking ‘‘and not less than once every 
other year thereafter’’ and inserting ‘‘and, for years 
before 2020, not less than once biennially (and, for 
years beginning with 2020, not less than annually) 
thereafter’’; and 
(2) by adding at the end the following new sen-
tence: ‘‘With respect to 2020 and each subsequent 
year, the Secretary shall submit each such report by 
not later than December 15 of such year.’’. 
SEC. 8. ADDRESSING OVERLAP IN VALUE-BASED CARE PRO-
GRAMS. 
(a) IN GENERAL.— 
(1) CMI.—Section 1115A(a)(5) of the Social 
Security Act (42 U.S.C. 1315a(a)(5)) is amended by 
adding at the end the following new sentence: ‘‘In 
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establishing such limits, the Secretary shall take into 
account payment and service delivery models in 
progress in such geographic areas.’’. 
(2) REPEAL OF MEDICARE DUPLICATION PRO-
HIBITION.—Section 1899(b) of the Social Security 
Act (42 U.S.C. 1395jjj(b)) is amended by striking 
paragraph (4)(A). 
(b) REPORT.—Not later than 60 days after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services shall conduct an assessment and submit 
to Congress a report on alternative payment model overlap 
under the Medicare program under title XVIII of the So-
cial Security Act. Such report shall include a description 
of and recommendations relating to— 
(1) appropriate participation in multiple alter-
native payment models for health care providers; 
(2) feasibility of adequate evaluation of alter-
native payment models if participants are partici-
pating in multiple arrangements; and 
(3) obstacles created by competing incentives 
with respect to alternative payment models. 
SEC. 9. MODEL ELIGIBILITY AND QUALITY OF CARE. 
(a) CLARIFICATION OF MODEL ELIGIBILITY.—Sec-
tion 1115A of the Social Security Act (42 U.S.C. 1315a) 
is amended— 
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(1) by striking ‘‘also’’ before ‘‘improve’’; and 
(2) in subsection (b)(2)(A), by inserting after 
the second sentence the following new sentence: 
‘‘The Secretary may also focus on models solely 
aimed at implementing practices to demonstrate ways to 
significantly improve the care, patient safety, and health 
outcomes of individuals receiving benefits under the appli-
cable title in anticipation that quality of care benefits and 
potential direct or indirect savings will over time accrue 
to the Medicare or Medicaid program.’’. 
(b) 
ADDITIONAL
OPPORTUNITY.—Section 
1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 
1315a(b)(2)(B)) is amended by adding at the end the fol-
lowing new clause: 
‘‘(xxviii) Implementing newly recog-
nized and evidence-based, professionally 
supported care delivery practices and bun-
dles to improve the efficient and effective 
delivery of hospital-based care and lead to 
enhanced patient outcomes, reductions in 
readmissions, or avoidance of costly med-
ical errors or complications.’’. 
(c) INCLUSION
OF
INDIRECT
SAVINGS.—Section 
1115A(b)(3)(A) of the Social Security Act (42 U.S.C. 
1315a(b)(3)(A)) is amended by inserting at the end ‘‘or 
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