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 Cen-
ter 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) intro-
duced 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 juris-
diction 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Strengthening Innova-
tion in Medicare and Medicaid Act’’. 
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SEC. 2. 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 or expanding pay-
ment and service deliver models under this section, 
the Secretary shall limit testing of a model— 
‘‘(A) to a period not to exceed 5 years; and 
‘‘(B) no more applicable individuals than 
necessary to obtain a statistically valid sam-
ple.’’. 
(b) MODEL REQUIREMENT WAIVERS
FOR HARD-
SHIP.—Section 1115A(a) of the Social Security Act (42 
U.S.C. 1315a(a)), as amended by subsection (a), is fur-
ther amended by adding at the end the following new para-
graph: 
‘‘(7) HARDSHIP WAIVERS.—Not later than 60 
days after the date of the enactment of the 
Strengthening Innovation in Medicare and Medicaid 
Act, the Secretary shall develop and implement a 
plan to allow providers of services and suppliers to 
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request a waiver from any requirement of a model 
if the Secretary determines that such requirement 
would result in undue economic hardship to such 
provider or supplier or loss of access to such pro-
vider or supplier for vulnerable populations.’’. 
(c) 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: 
‘‘(8) MONITORING IMPACT.—Not later than 60 
days after the date of the enactment of the 
Strengthening Innovation 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 the National 
Quality Forum Healthcare Disparities and Cul-
tural Competency Measure; and 
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‘‘(C) mitigate any adverse impact that the 
Secretary determines could affect beneficiary 
health.’’. 
SEC. 3. 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: 
‘‘(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 subsection (b) or (c), includ-
ing a proposed effective date and a summary of 
the determinations and certification made under 
paragraphs (1) through (3) of subsection (c), if 
applicable, to the Committee on Ways and 
Means and the Committee on Energy and Com-
merce of the House of Representatives and to 
the Committee on Finance and the Committee 
on Health, Education, Labor, and Pensions of 
the Senate. 
‘‘(B) The testing, expansion, or modifica-
tion of model proposed in a report submitted 
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under subparagraph (A) shall be carried out by 
the Secretary if the Congress does not, within 
45 days of receiving a report transmitted from 
the Secretary detailing the proposed testing or 
expansion including the proposed effective date 
for such testing or expansion and a summary of 
the determinations and certification made under 
paragraphs (1) through (3), pass a joint resolu-
tion disapproving of the proposed testing or ex-
pansion in accordance with the following proce-
dure: 
‘‘(i) The succeeding subparagraphs of 
this paragraph are enacted by Congress as 
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 
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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 provisions of this subparagraph, 
‘‘resolution’’ means only a joint resolution, 
the matter after the resolving clause of 
which is as follows: ‘That Congress dis-
approves 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 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 
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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 
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), 
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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 
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 OTHER HOUSE.—If, before the passage 
by one House of a joint resolution of that 
House, that House receives from the other 
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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, the vote on passage shall be 
on the joint resolution of the other 
House. 
‘‘(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 
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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 subparagraph (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 
shall be disregarded in computing the 
45-calendar day period described in 
subparagraph (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. 4. PUBLIC INPUT AND CONSULTATION. 
Section 1115A(d) of the Social Security Act (42 
U.S.C. 1315a(d)), as amended by section 3, is further 
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amended by adding at the end of the following new para-
graphs: 
‘‘(6) 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 subsections (b) 
and (c) of section 1115A. Such public notice shall 
describe and define the standards, criteria, and proc-
esses that the Secretary will use for selecting and 
evaluating— 
‘‘(A) during initial stages of model develop-
ment; 
‘‘(B) prior to testing under section (b)(1); 
‘‘(C) prior to modification of non-contrac-
tual models under section (b)(3)(B); and 
‘‘(D) following evaluation of a model under 
section (b)(4) and prior to rulemaking under 
section (c). 
Such notice shall explain the basis for the Sec-
retary’s determination that the conditions set forth 
in subsection (c) have been met. Additionally, the 
notice shall explain the basis for selection and the 
standards established by the Secretary under the 
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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). 
‘‘(7) CONSULTATION.—In carrying out the du-
ties under this section, the CMI shall consult rep-
resentatives of relevant Federal agencies, and clin-
ical and analytical experts with expertise in medicine 
and health care management, specifically such ex-
perts 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.’’. 
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SEC. 5. REESTABLISHING JUDICIAL REVIEW. 
Section 1115A(d)(2) of the Social Security Act (42 
U.S.C. 1315a(d)(2)) 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’’; 
(4) by redesignating subparagraph (D) as sub-
paragraph (C); 
(5) in subparagraph (E), at the end, by striking 
‘‘; and’’ and inserting a period; 
(6) by redesignating subparagraph (E) as sub-
paragraph (D); and 
(7) by striking subparagraph (F). 
SEC. 6. 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 
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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. 7. 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 
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)(4) of the Social Secu-
rity Act (42 U.S.C. 1395jjj(b)) is amended by strik-
ing subparagraph (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-
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cial Security Act. Such report shall include a description 
of and recommendations relating to— 
(1) any issues regarding the existence of mul-
tiple alternative payment model participation oppor-
tunities for health care providers; and 
(2) obstacles created by competing incentives 
with respect to alternative payment models. 
SEC. 8. GAO REPORT. 
Not later than 12 months after the date of enactment 
of this Act, the Comptroller General of the United States 
shall submit to Congress a report on the efforts of the 
Center for Medicare and Medicaid Innovation to attract, 
retain, and develop emerging experts, including under-rep-
resented individuals in medicine, such as women, racial 
and ethnic minorities, and other groups. Such report shall 
include an analysis of the impact of the existing authority 
provided to the Center for Medicare and Medicaid Innova-
tion to address workforce shortages and gaps in priority 
areas. 
SEC. 9. MODELS SPECIFICALLY TO IMPROVE QUALITY OF 
CARE. 
(a) CLARIFICATION OF MODEL ELIGIBILITY.—Sec-
tion 1115A of the Social Security Act (42 U.S.C. 1315a) 
is amended— 
(1) in subsection (a)(1)— 
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(A) by striking ‘‘while preserving or en-
hancing the quality of care’’ and inserting ‘‘or 
to enhance quality of care’’; and 
(B) 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 practices to significantly improve the care 
and health outcomes of individuals receiving benefits 
under the applicable title in anticipation that quality 
of care benefits and potential direct or indirect sav-
ings will accrue to the Medicare or Medicaid pro-
gram.’’. 
(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 
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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 
that savings cannot be made indirectly over time when 
testing quality of care delivery models.’’. 
(d) EVALUATING
QUALITY
OF
CARE.—Section 
1115A(b)(4) of the Social Security Act (42 U.S.C. 
1315a(b)(4)) is amended— 
(1) in subparagraph (A), by amending clause (i) 
to read as follows: 
‘‘(i) the quality of care furnished 
under the model, including the measure-
ment of patient-level outcomes, patient- 
centeredness, and any unintended con-
sequences, such as access to services, using 
criteria determined appropriate by the Sec-
retary for each model; and’’; and 
(2) in subparagraph (C), by striking ‘‘and’’ be-
fore ‘‘patient-centered care’’ and inserting ‘‘, are ap-
propriate to issues of quality outcomes related to the 
medical conditions under study, and are’’. 
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SEC. 10. EFFECTIVE DATE. 
Except as otherwise provided in the previous sections 
of this Act (or the amendments made by such sections), 
such amendments shall apply with respect to the testing, 
expansion, or modification of models on or after January 
1, 2020. 
Æ 
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