HR-2533-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
Sponsored by Jodey Arrington (R-TX)
What it does
This bill would require the Center for Medicare and Medicaid Innovation (CMMI) to design and test a new payment model — the Specialty Health Care Services Access Model — that connects Medicare, Medicaid, and CHIP beneficiaries in rural and underserved areas to specialty health care via telehealth and other remote technologies. Provider networks selected for the pilot must include at least 50 federally qualified health centers, rural health clinics, critical access hospitals, or rural emergency hospitals, with at least half located in rural areas, and must be nonprofit 501(c)(3) organizations with a track record in underserved communities. Any spending under the model would be subject to existing funding restrictions from Public Law 117-328.
Who benefits
Medicare Part A/B enrollees and Medicaid/CHIP beneficiaries in rural and underserved areas who currently lack access to specialty care. Federally qualified health centers, rural health clinics, critical access hospitals, and rural emergency hospitals that would gain new revenue streams and partnerships. Telehealth technology vendors and platforms that would be engaged to deliver services. Primary care providers in rural areas whose patients would gain specialist access without requiring travel. Nonprofit health networks with existing rural infrastructure that meet the selection criteria.
Who is hurt
Urban and suburban specialty care providers who may face increased competition from telehealth-based models. In-person specialty practices that could see reduced patient referrals if remote care expands. Taxpayers who would bear the cost of the pilot program, though the bill does not specify an appropriation amount. Provider networks that do not meet the strict 501(c)(3) and rural-composition requirements would be ineligible to participate. States with existing Medicaid managed care arrangements may face administrative complexity in coordinating with the new federal model.
Supporters argue
Supporters argue that rural Americans face a severe specialty care shortage — the Health Resources and Services Administration designates over 7,700 health professional shortage areas, disproportionately in rural regions — and that telehealth has demonstrated effectiveness in bridging geographic gaps. They contend that routing specialty care through existing trusted community health infrastructure (federally qualified health centers and critical access hospitals) ensures coordination with primary care and avoids fragmented treatment, while the CMMI pilot structure allows evidence-based evaluation before any broader rollout.
Opponents argue
Opponents argue that CMMI has already tested numerous payment models with mixed results — a 2023 HHS Office of Inspector General review found that most CMMI models have not generated net savings — and that mandating a specific model design in statute limits CMMI's flexibility to adapt based on evidence. They contend that the strict network eligibility requirements (501(c)(3) status, 50-facility minimum, multi-region presence) may exclude smaller or newer rural organizations best positioned to serve specific communities, effectively concentrating federal contracts among a narrow set of established entities.