S-5267-119
Read twice and referred to the Committee on Finance.
Sponsored by Jim Banks (R-IN)
What it does
This bill would require the Center for Medicare and Medicaid Innovation (CMMI) to launch and run a pilot program — called the Accountable Produce is Medicine Bundled Payment Model — for at least 5 years, beginning within 180 days of enactment. The program would provide bundled payments to at least 5 selected healthcare programs to deliver food-based services (fresh produce, nutrition counseling, telehealth, remote monitoring, and lifestyle coaching) to Medicare, Medicaid, and CHIP enrollees with chronic conditions such as diabetes, obesity, cardiovascular disease, and hypertension who live in medically underserved or rural areas. Participants would receive these services with no cost-sharing (no copays or deductibles) for up to one year, with possible re-enrollment, and could be disenrolled for insufficient engagement.
Who benefits
Medicare, Medicaid, and CHIP enrollees with diet-related chronic diseases (diabetes, obesity, hypertension, cardiovascular disease) living in medically underserved, rural, or health professional shortage areas. Local and regional farmers and food producers within 250 miles of participating programs, and those using regenerative agriculture practices. Registered dietitians and nutrition counselors who would be reimbursed as qualified providers. Community health organizations and food-as-medicine nonprofits that could qualify as selected programs. Telehealth and remote patient monitoring companies. Indirectly, federal and state governments if the model reduces downstream healthcare spending.
Who is hurt
Taxpayers and the federal budget, which would bear the cost of bundled payments and waived cost-sharing. Patients who are disenrolled for non-adherence, who could lose access to services mid-year. Programs or providers in urban, non-shortage areas who are ineligible to participate. Competing healthcare delivery models or vendors not selected for the pilot. Patients outside the eligible geographic or diagnostic criteria who have similar needs but cannot participate. States may face administrative burdens coordinating Medicaid and CHIP participation in the model.
Supporters argue
Supporters argue that diet-related chronic diseases account for a disproportionate share of U.S. healthcare spending — the CDC estimates that 90% of the nation's $4.1 trillion in annual healthcare expenditures go toward chronic and mental health conditions, many of which are diet-related. They contend that food-is-medicine interventions have demonstrated measurable results in peer-reviewed studies, including reduced hospitalizations and improved blood glucose and blood pressure control, and that testing this model through CMMI — the same mechanism used to develop value-based care models — is a fiscally responsible, evidence-driven approach. The bipartisan sponsorship (Banks, Padilla, Marshall) further suggests the model addresses a broadly shared public health concern.
Opponents argue
Opponents argue that CMMI pilot programs have a mixed track record of generating savings, and that mandating a specific model by statute — rather than allowing CMMI to select models based on evidence — undermines the agency's flexibility and scientific independence. They contend that the disenrollment provision, which cuts off services to patients deemed non-adherent, may disproportionately harm the most socioeconomically vulnerable enrollees, who face the greatest barriers to program engagement. Critics may also question whether a minimum 5-program, 5-year mandate represents an efficient use of federal healthcare dollars without stronger preliminary evidence of cost savings at scale.
Constitutional context
Congress has broad authority to structure Medicare, Medicaid, and CHIP spending under the Taxing and Spending Clause (Art. I, §8, cl. 1). NFIB v. Sebelius (2012) affirmed Congress's power to design and condition federal healthcare spending programs, though it cautioned that conditions on states must leave genuine choice. Because this bill directs CMMI — a federal agency — to run a specific model, it also implicates the post-Loper Bright (2024) landscape, where courts independently review agency statutory interpretations and the scope of delegated authority, potentially scrutinizing how broadly the Secretary defines eligible conditions or food standards.
Checks and balances
The executive branch (HHS Secretary and CMMI) gains new mandatory spending and program-design authority; Congress checks this through the statutory requirements, minimum program standards, and the existing CMMI evaluation and expansion framework under Section 1115A of the Social Security Act.
Historical precedent
CMMI has previously tested food-related interventions under its existing authority, including the Maternal Opioid Misuse model and various community health worker models, but no prior federal statute has mandated a specific produce-based bundled payment model of this structure.