HR-8355-119
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 Lloyd Smucker (R-PA)
What it does
This bill would require the Center for Medicare and Medicaid Innovation to test a new "Accountable Produce is Medicine" bundled payment model in at least 5 selected programs for at least 5 years. Eligible patients with chronic conditions like diabetes, obesity, or hypertension in underserved or rural areas would receive services such as nutrition counseling, telehealth, remote monitoring, and produce/healthy food provisions without copays or deductibles, with programs paid through bundled payments and subject to performance-based financial risk starting in year three.
Who benefits
Medicare, Medicaid, and CHIP beneficiaries with chronic diseases living in medically underserved, rural, or health-professional-shortage areas who are selected for the model; healthcare providers and suppliers (including those partnering with local farms) chosen to operate selected programs; registered dietitians and nutrition counselors; local and regional produce growers within 250 miles of program sites, especially those using regenerative agriculture.
Who is hurt
Federal and state governments bear the administrative and payment costs of running the model; eligible individuals who are disenrolled for inadequate engagement lose access to services; providers or programs not selected among the initial five are excluded from participation; taxpayers may bear costs if the model does not achieve projected savings; food suppliers located more than 250 miles from program sites or using conventional (non-regenerative) methods may be disadvantaged in selection priority.
Supporters argue
Supporters argue that diet-related chronic diseases like diabetes and cardiovascular disease are a leading driver of health care costs, and that food-is-medicine interventions have shown promise in pilot studies for improving outcomes and reducing spending. They contend that testing this model through the Innovation Center, with cost-sharing waived and outcome data collected quarterly, allows evidence-based evaluation before any broader rollout, targeting resources toward underserved and rural populations who face the greatest nutrition access barriers.
Opponents argue
Opponents argue that mandating a specific five-year, five-program model with detailed eligibility and disenrollment criteria substitutes congressional judgment for CMS's own evidence-based innovation process, potentially locking in an unproven intervention before rigorous evidence exists. They contend that provisions preferencing produce grown within 250 miles or using regenerative agriculture may function as a form of economic favoritism unrelated to health outcomes, and that disenrolling non-adherent patients from cost-sharing-free services could disproportionately burden those with the least stable access to transportation, technology, or food storage.
Constitutional context
Congress is exercising its Spending Clause authority under Article I, Section 8 to direct how Medicare, Medicaid, and CHIP funds are administered through the existing Center for Medicare and Medicaid Innovation, similar to the spending-based structure upheld generally in NFIB v. Sebelius (2012) for federal healthcare funding conditions, though this bill does not impose new conditions on states comparable to the Medicaid expansion at issue there.
Checks and balances
Congress directs the Secretary of Health and Human Services to implement a specific pilot model, with HHS retaining discretion over selection criteria, payment amounts, and program standards, subject to ordinary administrative and judicial review.
Historical precedent
The Center for Medicare and Medicaid Innovation has tested numerous bundled-payment and food-is-medicine-adjacent pilot models since its creation under the Affordable Care Act, though no prior federal statute has mandated a produce-specific bundled payment model of this design.