,i  #aafth ,,congress  #b;d ,session    
,h4 ,r4 #egda  ,,in ,,the ,,house ,,of  
,,representatives  ,february #c1        
#bjbj,ms4 ,sewell of ,alabama 7for      
herself1 ,mr4 ,smith of ,nebraska1 ,mr4 
,crdenas1 ,mr4 ,shimkus1 ,mr4 ,wenstrup1
 and ,mr4 ,schrader7 introduced the     
following bill2 which was referred to   
the ,committee on ,energy and ,commerce1
 and in addition to the ,committees on  
,ways and ,means1 and ,rules1 for a     
period to be subsequently determined by 
the ,speaker1 in each case for          
consideration of such provisions as fall
 within the jurisdiction 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 ,innovation1 and
 for other purposes4  #a4 ,short title  
,this ,act may be cited as the          
,strengthening ,innovation in ,medicare 
and ,medicaid ,act4  #b4 ,defining ,,cmi

 model testing parameters  7a7 ,scope   
and duration of models ,section         
#aaae;,a7a7 of the ,social ,security    
,act 7#db ,u4,s4,c4 #acae;a7a77 is      
amended by adding at the end the        
following new paragraph3  7#f7 ,scope   
and duration of models tested ,beginning
 on or after the date of the enactment  
of the ,strengthening ,innovation in    
,medicare and ,medicaid ,act1 for       
purposes of testing new payment and     
service delivery models or expanding    
payment and service deliver models under
 this section1 the ,secretary shall     
limit testing of a model--  7,a7 to a   
period not to exceed #e years2 and  7,b7
 no more applicable individuals than    
necessary to obtain a statistically     
valid sample4  4  7b7 ,model requirement
 waivers for hardship ,section          
#aaae;,a7a7 of the ,social ,security    
,act 7#db ,u4,s4,c4 #acae;a7a771 as     
amended by subsection 7a71 is further   
amended by adding at the end the        
following new paragraph3  7#g7 ,hardship

 waivers ,not later than #fj days after 
the date of the enactment of the        
,strengthening ,innovation in ,medicare 
and ,medicaid ,act1 the ,secretary shall
 develop and implement a plan to allow  
providers of services and suppliers to  
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  
provider or supplier for vulnerable     
populations4  4  7c7 ,monitoring impact 
,section #aaae;,a7a7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#acae;a7a771 as amended by subsections  
7a7 and 7b71 is further amended by      
adding at the end the following new     
paragraph3  7#h7 ,monitoring impact ,not
 later than #fj days after the date of  
the enactment of the ,strengthening     
,innovation in ,medicare and ,medicaid  
,act1 the ,secretary shall develop and  
implement a plan to--  7,a7 monitor     
continuously and on a real-time basis   

the effect of a model under subsection  
7b7 on applicable individuals1 and      
mitigate any adverse impact1 such as    
inappropriate reductions in care or     
reduced access to care2  7,b7 assess and
 track the impact of delivery and       
payment models on health disparities1   
using existing measures such as the     
,national ,quality ,forum ,healthcare   
,disparities and ,cultural ,competency  
,measure2 and  7,c7 mitigate any adverse
 impact that the ,secretary determines  
could affect beneficiary health4  4  #c4
 ,implementation of testing and         
expansion of models with ,congressional 
inaction ,section #aaae;,a7d7 of the    
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7d77 is amended by adding at the 
end the following new paragraph3  7#d7  
,implementation of testing and expansion
 of models with ,congressional inaction 
7,a7 ,the ,secretary shall transmit a   
proposal for the testing1 expansion1 or 
modification of a model under subsection
 7b7 or 7c71 including a proposed       

effective date and a summary of the     
determinations and certification made   
under paragraphs 7#a7 through 7#c7 of   
subsection 7c71 if applicable1 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 ,health1 ,education1      
,labor1 and ,pensions of the ,senate4   
7,b7 ,the testing1 expansion1 or        
modification of model proposed in a     
report submitted under subparagraph 7,a7
 shall be carried out by the ,secretary 
if the ,congress does not1 within #de   
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 7#a7 through 7#c71
 pass a joint resolution disapproving of
 the proposed testing or expansion in   
accordance with the following procedure3

  7i7 ,the succeeding subparagraphs of  
this paragraph are enacted by ,congress 
as an exercise of the rulemaking power  
of the ,senate and the ,house of        
,representatives1 respectively1 and as  
such they shall be deemed a part of the 
rules of each ,house1 respectively1 but 
applicable only with the respect to the 
procedure to be followed in that ,house 
in the case of resolutions described in 
subparagraph 7,b74 ,they shall supersede
 other rules only to the extent that    
they are inconsistent therewith4 ,they  
are enacted with full recognition of the
 constitutional right of either ,house  
to change the rules 7so far as relating 
to the procedure of that ,house7 at any 
time1 in the same manner and to the same
 extent as in the case of any ruse of   
that ,house4  7ii7 ,for the purpose of  
the succeeding provisions of this       
subparagraph1 8resolution0 means only a 
joint resolution1 the matter after the  
resolving clause of which is as follows3
 #8,that ,congress disapproves the model

 expansion requested pursuant to section
 #aaae;,a7c7 of the ,social ,security   
,act transmitted by the ,secretary on 1 
and such an expansion shall not         
proceed4'1 the blank space therein being
 filled with the date on which the      
,secretary's message proposing such     
expansion was delivered4  7iii7 ,upon   
receipt of a report submitted to        
,congress under subparagraph 7c77#d71   
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       
,health1 ,education1 ,labor1 and        
,pensions of the ,senate4  7iv7 ,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 ,health1 ,education1      

,labor1 and ,pensions of the ,senate4   
7v7 ,if a committee to which has been   
referred a resolution has not reported  
it before the expiration of #aj         
legislative days after its introduction1
 it shall then 7but not before7 be in   
order to move to discharge the committee
 from further consideration of that     
resolution1 or to discharge the         
committee from further consideration of 
any other resolution with respect to the
 proposed expansion which has been      
referred to the committee4 ,the motion  
to discharge may be made only by a      
person favoring the resolution1 shall be
 highly privileged 7except that it may  
not be made after the committee has     
reported a resolution with respect to   
the same proposed expansion71 and debate
 thereon shall be limited to not more   
than #a hour1 to be divided equally     
between those favoring and those        
opposing the resolution4 ,an amendment  
to the motion is not in order1 and it is
 not in order to move to reconsider the 

vote by which the motion is agreed to or
 disagreed to4 ,if the motion to        
discharge is agreed to or disagreed to1 
the motion may not be renewed1 nor may  
another motion to discharge the         
committee be made with respect to any   
other resolution with respect to the    
same proposed expansion4  7vi7 ,when the
 committee has reported1 or has been    
discharged from further consideration of
 a resolution1 it is at any time        
thereafter in order 7even though a      
previous motion to the same effect has  
been disagreed to7 to move to proceed to
 the consideration of the resolution4   
,the motion is highly privileged and is 
not debatable4 ,an amendment to the     
motion is not in order1 and it is not in
 order to move to reconsider the vote by
 which the motion is agreed to or       
disagreed to4 ,debate on the resolution 
shall be limited to not more than #b    
hours1 which shall be divided equally   
between those favoring and those        
opposing the resolution4 ,a motion      

further to limit debate is not          
debatable4 ,an amendment to1 or motion  
to recommit1 the resolution is not in   
order1 and it is not in order to move to
 reconsider the vote by which the       
resolution is agreed to or disagreed to4
  7vii7 ,motions to postpone1 made with 
respect to the discharge from committee1
 or the consideration of1 a resolution  
and motions to proceed to the           
consideration of other business shall be
 decided without debate4 ,appeals from  
the decision of the ,chair relating to  
the application of the rules of the     
,senate or the ,house of                
,representatives1 as the case may be1 to
 the procedure relating to a resolution 
shall be decided without debate4  7viii7
 ,coordination with action by other     
,house ,if1 before the passage by one   
,house of a joint resolution of that    
,house1 that ,house receives from the   
other ,house a joint resolution1 then   
the following procedures shall apply3   
7,i7 ,the joint resolution of the other 

,house shall not be referred to a       
committee4  7,,ii7 ,with respect to a   
joint resolution of the ,house receiving
 the resolution1 the procedure in that  
,house shall be the same as if no joint 
resolution had been received from the   
other ,house1 the vote on passage shall 
be on the joint resolution of the other 
,house4  7ix7 ,if one ,house fails to   
introduce or consider a joint resolution
 under this section1 the joint          
resolution of the other ,house shall be 
entitled to expedited floor procedures  
under this section4  7x7 ,if1 following 
passage of the joint resolution in the  
,senate1 the ,senate then receives the  
companion measure from the ,house of    
,representatives1 the companion measure 
shall not be debatable4  7xi7 ,if       
,congress passes a joint resolution1 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            
#de-;calendar day period described in   
subparagraph 7c77#d74  7xii7 ,if the    
,president vetoes the joint resolution--
 7,i7 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         
#de-;calendar day period described in   
subparagraph 7c77#d71 and  7,,ii7 debate
 on a veto message in the ,senate under 
this section shall be #a hour equally   
divided between the majority and        
minority leaders or their designees4  4 
#d4 ,public input and consultation      
,section #aaae;,a7d7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#acae;a7d771 as amended by section #c1  
is further amended by adding at the end 
of the following new paragraphs3  7#f7  
,public input ,the ,secretary shall use 
a process involving advance public      
notice and an opportunity for           

stakeholder input and public comments to
 ensure transparency and accountability 
regarding the establishment1 testing1   
implementation1 evaluation1 and         
expansion of a model under subsections  
7b7 and 7c7 of section #aaae;,a4 ,such  
public notice shall describe and define 
the standards1 criteria1 and processes  
that the ,secretary will use for        
selecting and evaluating--  7,a7 during 
initial stages of model development2    
7,b7 prior to testing under section     
7b77#a72  7,c7 prior to modification of 
non-contractual models under section    
7b77#c77;,b72 and  7,d7 following       
evaluation of a model under section     
7b77#d7 and prior to rulemaking under   
section 7c74  ,such notice shall explain
 the basis for the ,secretary's         
determination that the conditions set   
forth in subsection 7c7 have been met4  
,additionally1 the notice shall explain 
the basis for selection and the         
standards established by the ,secretary 
under the regulations issued under      

paragraph 7#a71 and any additional      
factors that will be used to test the   
model's impact on quality of care1      
patient-centeredness1 and innovation4   
,the notice shall provide a minimum     
#de-;day period for public comment4 ,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 7b77#a74  7#g7 
,consultation ,in carrying out the      
duties under this section1 the ,,cmi    
shall consult representatives of        
relevant ,federal agencies1 and clinical
 and analytical experts with expertise  
in medicine and health care management1 
specifically such experts with expertise
 in--  7,a7 the health care needs of    
minority1 rural1 and underserved        
populations2 and  7,b7 the financial    
needs of safety net1 community based1   
rural1 and critical access providers1   
including federally qualified health    
centers4  ,the ,,cmi shall use open door

 forums or other mechanisms to seek     
external feedback from interested       
parties and incorporate that feedback   
into the development of models4  4  #e4 
,reestablishing judicial review ,section
 #aaae;,a7d77#b7 of the ,social         
,security ,act 7#db ,u4,s4,c4           
#acae;a7d77#b77 is amended-- 7#a7 in the
 matter preceding subparagraph 7,a71 by 
inserting after or otherwise the        
following3 7except as may be necessary  
to enforce requirements of this section 
or other laws or constitutional         
provisions intended to protect          
beneficiaries of affected programs72    
7#b7 by striking subparagraph 7,c72     
7#c7 in subparagraph 7,d71 by adding at 
the end 2 and2  7#d7 by redesignating   
subparagraph 7,d7 as subparagraph 7,c72 
7#e7 in subparagraph 7,e71 at the end1  
by striking 2 and and inserting a       
period2  7#f7 by redesignating          
subparagraph 7,e7 as subparagraph 7,d72 
and  7#g7 by striking subparagraph 7,f74
  #f4 ,revision of reporting requirement

 ,section #aaae;,a7g7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#acae;a7g77 is amended-- 7#a7 by        
striking and not less than once every   
other year thereafter and inserting and1
 for years before #bjbj1 not less than  
once biennially 7and1 for years         
beginning with #bjbj1 not less than     
annually7 thereafter2 and  7#b7 by      
adding at the end the following new     
sentence3 ,with respect to #bjbj and    
each subsequent year1 the ,secretary    
shall submit each such report by not    
later than ,december #ae of such year44 
#g4 ,addressing overlap in value based  
care programs  7a7 ,in general  7#a7    
,,cmi ,section #aaae;,a7a77#e7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7a77#e77 is amended by adding at 
the end the following new sentence3 ,in 
establishing such limits1 the ,secretary
 shall take into account payment and    
service delivery models in progress in  
such geographic areas44  7#b7 ,repeal of
 ,medicare duplication prohibition      

,section #ahii7;b77#d7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acie;jjj7b77 is amended by striking    
subparagraph 7,a74  7b7 ,report ,not    
later than #fj days after the date of   
the enactment of this ,act1 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 ,social ,security ,act4  
,such report shall include a description
 of and recommendations relating to--   
7#a7 any issues regarding the existence 
of multiple alternative payment model   
participation opportunities for health  
care providers2 and  7#b7 obstacles     
created by competing incentives with    
respect to alternative payment models4  
#h4 ,,gao report ,not later than #ab    
months after the date of enactment of   
this ,act1 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 attract1 retain1 and     
develop emerging experts1 including     
under-represented individuals in        
medicine1 such as women1 racial and     
ethnic minorities1 and other groups4    
,such report shall include an analysis  
of the impact of the existing authority 
provided to the ,center for ,medicare   
and ,medicaid ,innovation to address    
workforce shortages and gaps in priority
 areas4  #i4 ,models specifically to    
improve quality of care  7a7            
,clarification of model eligibility     
,section #aaae;,a of the ,social        
,security ,act 7#db ,u4,s4,c4 #acae;a7  
is amended-- 7#a7 in subsection         
7a77#a7--  7,a7 by striking while       
preserving or enhancing the quality of  
care and inserting or to enhance quality
 of care2 and  7,b7 by striking also    
before improve2 and  7#b7 in subsection 
7b77#b77;,a7 by inserting after the     
second sentence the following new       
sentence3 ,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 savings will accrue to the     
,medicare or ,medicaid program44  7b7   
,additional opportunity ,section        
#aaae;,a7b77#b77;,b7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#acae;a7b77#b77;,b77 is amended by      
adding at the end the following new     
clause3  7xxviii7 ,implementing newly   
recognized and evidence-based1          
professionally supported care delivery  
practices and bundles to improve the    
efficient and effective delivery of     
hospital-based care and lead to enhanced
 patient outcomes1 reductions in        
readmissions1 or avoidance of costly    
medical errors or complications4  4  7c7
 ,inclusion of indirect savings ,section
 #aaae;,a7b77#c77;,a7 of the ,social    
,security ,act 7#db ,u4,s4,c4           

#acae;a7b77#c77;,a77 is amended by      
inserting at the end or that savings    
cannot be made indirectly over time when
 testing quality of care delivery       
models44  7d7 ,evaluating quality of    
care ,section #aaae;,a7b77#d7 of the    
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7b77#d77 is amended-- 7#a7 in    
subparagraph 7,a71 by amending clause   
7i7 to read as follows3  7i7 the quality
 of care furnished under the model1     
including the measurement of            
patient-level outcomes1                 
patient-centeredness1 and any unintended
 consequences1 such as access to        
services1 using criteria determined     
appropriate by the ,secretary for each  
model2 and  2 and  7#b7 in subparagraph 
7,c71 by striking and before            
patient-centered care and inserting 1   
are appropriate to issues of quality    
outcomes related to the medical         
conditions under study1 and are4  #aj4  
,effective date ,except as otherwise    
provided in the previous sections of    

this ,act 7or the amendments made by    
such sections71 such amendments shall   
apply with respect to the testing1      
expansion1 or modification of models on 
or after ,january #a1 #bjbj4