PlainBillCongress, translated.Legislation. Context. Public interest.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 jurisdiction of the committee concerned.
Congressional Research Service
No official summary is available in the imported record yet.
People & committees
Rep. Smith, Adrian [R-NE-3] · R–NE
Legislative record
A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.
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 jurisdiction of the committee concerned.
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 jurisdiction of the committee concerned.
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 jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Oct 14, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-10-01 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
This proposal would change how the Center for Medicare and Medicaid Innovation tests ways to pay for and deliver health care. It would limit early-stage tests, allow providers to request hardship waivers, and require monitoring of patients’ access to care. It would add public input and congressional review, while allowing tests focused on improving care in anticipation of possible savings over time. The changes would affect patients, participating health care providers and suppliers, and officials administering the tests.
the Secretary shall limit testing of a Phase I model— (A) to a period not to exceed 5 years; and (B) to the lesser of 10 percent of applicable individuals or 500,000 beneficiaries.
allow applicable providers of services or supplies to request a waiver from any requirement of a model
monitor continuously and on a real-time basis the effect of a model under subsection (b) on applicable individuals, and mitigate any adverse impact, such as inappropriate reductions in care or reduced access to care
The Secretary shall use a process involving advance public notice and an opportunity for stakeholder input and public comments
if Congress does not, within 45 days of receiving such report, pass a joint resolution disapproving of the proposed testing or expansion
The Secretary may also focus on models solely aimed at implementing practices to demonstrate ways to significantly improve the care, patient safety, 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 over time accrue to the Medicare or Medicaid program.
The bill would be called the Strengthening Innovation in Medicare and Medicaid Act.
This Act may be cited as the Strengthening Innovation in Medicare and Medicaid Act.
Congress would express support for starting tests on a limited scale, expanding them when results justify it, using mandatory participation sparingly, and ending unsuccessful models. These statements describe Congress’s views and intended approach; they do not establish that testing produces those results.
It is the sense of Congress that:
The model testing process is intended to test concepts on a limited scale first in Phase I, then assess initial results, and, if results merit, expand the model to a larger test in Phase II to confirm the initial results.
CMI should focus its attention on models most likely to succeed and should continually assess models and terminate those which are not generating results in keeping with its purpose—lowering costs while maintaining or preserving patient outcomes.
Mandatory models may be necessary to test certain payment models but should be used judiciously and be as limited in scope as possible to minimize accidental adverse impacts.
Beginning at enactment, the Secretary would have to limit an initial, or Phase I, model test to five years and to the smaller of 10 percent of applicable individuals or 500,000 beneficiaries.
Beginning on or after the date of the enactment of the Strengthening Innovation In Medicare and Medicaid Act, for purposes of testing new payment and service delivery models, the Secretary shall limit testing of a Phase I model— (A) to a period not to exceed 5 years; and (B) to the lesser of 10 percent of applicable individuals or 500,000 beneficiaries.
Starting in fiscal year 2027, the Center could start no more than six new Phase I models per fiscal year. It also could not simultaneously test more than five Phase I models requiring participation.
During each fiscal year starting with fiscal year 2027, CMI shall initiate Phase I testing of no more than 6 new models each fiscal year. Additionally, CMI shall not concurrently test more than 5 Phase I models which involve mandatory, involuntary, or compulsory participation.
Within 60 days after enactment, the Secretary would have to develop and implement a plan allowing applicable providers and suppliers to request waivers from model requirements. The provision conditions this route on the Secretary’s determination that a requirement would cause undue economic hardship to the provider or supplier or loss of access to services or supplies for vulnerable populations. It does not guarantee that a requested waiver would be granted.
Not later than 60 days after the enactment of the Strengthening Innovation in Medicare and Medicaid Act, the Secretary shall develop and implement a plan to allow applicable providers of services or supplies 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 healthcare services or supplies for vulnerable populations.
Within 60 days after enactment, the Secretary would have to implement a plan for continuous, real-time monitoring of model effects on patients. The plan would have to mitigate adverse effects, including inappropriate reductions in care, reduced access, and effects the Secretary determines could harm beneficiary health.
Not later than 60 days after 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 subsection (b) on applicable individuals, and mitigate any adverse impact, such as inappropriate reductions in care or reduced access to care; and (B) mitigate any adverse impact that the Secretary determines could affect beneficiary health.
The Secretary would have to send proposals to test, expand, or modify models to four congressional committees. Each proposal would include an intended effective date and, when applicable, a summary of the determinations and certification under the referenced expansion provisions.
The Secretary shall transmit a proposal for the testing, expansion, or modification of a model under subsections (b) and (c), including 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 Commerce of the House of Representatives and to the Committee on Finance and the Committee on Health, Education, Labor, and Pensions of the Senate.
The bill says the Secretary would carry out proposed testing, expansion, or modification if Congress does not pass a disapproval resolution within 45 days of receiving the report. However, the prescribed resolution language addresses only expansion, leaving uncertainty about how this procedure would apply to testing or modification.
The testing, expansion, or modification of a model proposed in a report submitted under subparagraph (A) shall be carried out by the Secretary if Congress does not, within 45 days of receiving such report, pass a joint resolution disapproving of the proposed testing or expansion
resolution means only a joint resolution, the matter after the resolving clause of which is as follows: That Congress disapproves the model expansion requested pursuant to section 1115A(c) of the Social Security Act transmitted by the Secretary on _____, and such an expansion shall not proceed.
If a committee had not reported a disapproval resolution within 10 legislative days after introduction, a supporter could move to remove it from committee consideration. Debate on that motion would be limited to one hour, divided equally between supporters and opponents; amendments and reconsideration would be barred.
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
The motion to discharge may be made only by a person favoring the resolution, shall be highly privileged (except that it may not be made after the committee has reported a resolution with respect to the same proposed expansion), and debate thereon shall be limited to not more than 1 hour, to be divided equally between those favoring and those opposing the resolution. An amendment to the motion is not in order, and it is not in order to move to reconsider the vote by which the motion is agreed to or disagreed to.
Once a disapproval resolution reached the full House or Senate through the specified procedure, debate on it would be limited to two hours, equally divided. Members could not amend it, send it back to committee, or reconsider its final vote. Either chamber would retain its authority to change its own rules.
Debate on the resolution shall be limited to not more than 2 hours, which shall be divided equally between those favoring and those opposing the resolution.
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 resolution is agreed to or disagreed to.
They are enacted with full recognition of the constitutional right of either House to change the rules (so far as relating to the procedure of that House) at any time
The bill would coordinate consideration of disapproval resolutions between the chambers. A resolution received from the other chamber before passage would bypass committee referral, and the final vote would be on that received resolution. One chamber’s failure to introduce or consider a resolution would not remove the other chamber’s access to expedited procedures.
If, before the passage by one House of a joint resolution of that House, that House receives from the other 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.
the vote on passage shall be on the joint resolution of the other House.
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.
The bill’s clock provisions would exclude the time between presenting a passed resolution to the President and presidential action. After a veto, they would also exclude the time until Congress receives the veto message. Senate debate on a veto message would be limited to one hour, equally divided between the majority and minority leaders or their designees. These clauses refer to subsection (c)(4), although section 4 places the new review procedure in subsection (d)(4), leaving the cross-reference uncertain.
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 expansion of models with congressional inaction
If Congress passes a joint resolution, 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 45-calendar day period described in subsection (c)(4).
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 subsection (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.
The Secretary would have to provide advance public notice and opportunities for input during model development and before specified testing, modification, and expansion steps. Notices would explain selection and evaluation standards, the basis for relevant expansion determinations, and factors used to assess care quality, attention to patients’ needs, and innovation. Public comment periods would last at least 45 days, and the Secretary would have to consider stakeholder comments when deciding whether to refine a model or proceed with testing.
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 establishment, testing, implementation, evaluation, and expansion of a model under section 1115A(b) and (c).
Such public notice shall describe and define the standards, criteria, and processes that the Secretary will use for selecting and evaluating— (A) during initial stages of model development; (B) prior to testing under subsection (b)(1); (C) prior to modification of non-contractual models under subsection (b)(3)(B); and (D) following evaluation of a model under subsection (b)(4) and prior to rulemaking under subsection (c).
Such notice shall explain the basis for the Secretary’s determination that the conditions set forth in section 1115A(c) of the Social Security Act (42 U.S.C. 1315a(c)) have been met.
Additionally, the notice shall explain the basis for selection and the standards established by the Secretary under the regulations issued under paragraph (1), and any additional 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).
The Center would have to consult relevant federal agencies and health care experts, specifically including experts on the financial needs of safety-net, community-based, rural, and critical-access providers and federally qualified health centers. It would also have to seek outside feedback through open forums or other methods and incorporate that feedback into model development.
the CMI shall consult representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management, specifically such experts with expertise in the financial needs of safety net, community-based, rural, and critical access providers, including federally qualified health centers.
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 models.
The section titled “Reestablishing judicial review” would add an exception for enforcement of this section and other laws or constitutional provisions intended to protect program beneficiaries. It would also delete subparagraphs (C) and (F) of the existing review provision. Because the existing text is not reproduced, the precise scope of the resulting review rights cannot be determined from this bundle.
6. Reestablishing judicial review
in the matter preceding subparagraph (A), by inserting (except as may be necessary to enforce the requirements of this section or other laws or constitutional provisions intended to protect beneficiaries of affected programs) after or otherwise
(2) by striking subparagraph (C)
(6) by striking subparagraph (F).
The bill would change the referenced reporting schedule from at least once every two years to at least annually beginning in 2027. Reports for 2027 and later years would be due by December 15 of each year.
by striking and not less than once every other year thereafter and inserting and, for years before 2027, not less than once biennially (and, for years beginning with 2027, not less than annually) thereafter
With respect to 2027 and each subsequent year, the Secretary shall submit each such report by not later than December 15 of such year.
When setting limits under the referenced model provision, the Secretary would have to consider payment and care-delivery models already operating in the relevant geographic areas. The bill would also delete a provision under the heading “Repeal of Medicare duplication prohibition.” Neither the existing limits nor the deleted prohibition is reproduced, so their full practical meaning is uncertain here.
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.
Repeal of Medicare duplication prohibition Section 1899(b) of the Social Security Act (42 U.S.C. 1395jjj(b)) is amended by striking paragraph (4)(A).
Within 60 days after enactment, the Secretary of Health and Human Services would have to assess overlapping Medicare payment models and report to Congress. The report would address providers’ participation in multiple models, whether those models can still be adequately evaluated, and problems caused by competing incentives.
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 Social Security Act.
Such report shall include a description of and recommendations relating to— (1) appropriate participation in multiple alternative payment models for health care providers; (2) feasibility of adequate evaluation of alternative payment models if participants are participating in multiple arrangements; and (3) obstacles created by competing incentives with respect to alternative payment models.
The Secretary could focus on models aimed solely at demonstrating substantial improvements in care, patient safety, and health outcomes, in anticipation of quality benefits and possible direct or indirect Medicare or Medicaid savings over time. This is permission to focus on such models, not a guarantee of savings. The bill would also delete “also” before “improve” in section 1115A(a)(1); the surrounding statutory sentence is not supplied.
The Secretary may also focus on models solely aimed at implementing practices to demonstrate ways to significantly improve the care, patient safety, 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 over time accrue to the Medicare or Medicaid program.
in subsection (a)(1), by striking also before improve
The bill would add newly recognized, evidence-based, professionally supported hospital care practices and bundles to the listed model opportunities. Their stated aims include more efficient and effective care, better outcomes, fewer readmissions, and avoidance of costly errors or complications; these are proposed aims rather than demonstrated effects.
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 following new clause: (xxviii) Implementing newly recognized and evidence-based, professionally supported care delivery practices and bundles to improve the efficient and effective delivery of hospital-based care and lead to enhanced patient outcomes, reductions in readmissions, or avoidance of costly medical errors or complications.
The bill would add language about whether savings can be achieved indirectly over time when testing care-quality models. The sentence being amended is not supplied, so the full condition and its consequences cannot be explained from this addition alone.
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 or that savings cannot be made indirectly over time when testing quality of care delivery models before the period at the end.
Participating providers and suppliers would have to receive the assumptions and data used by the Centers for Medicare & Medicaid Services’ Chief Actuary when making or declining to make the referenced certifications. That information would also have to appear in any rules concerning possible termination, modification, or expansion. The expansion disclosure provision expressly includes participants in demonstration projects.
The Secretary shall provide to each provider of services and supplier participating in a model, and include in any rules promulgated with respect to the consideration of such model for termination or modification, the assumptions and data used by the Chief Actuary of the Centers for Medicare & Medicaid Services as the basis for making (or declining to make) the certification described in clause (i) with respect to such model.
The Secretary shall provide to each provider of services and supplier participating in a model or demonstration project, and include in any rules promulgated with respect to the consideration of such model for expansion, the assumptions and data used by the Chief Actuary of the Centers for Medicare & Medicaid Services as the basis for making (or declining to make) the certification described in paragraph (2) with respect to such model.
Model evaluations would have to assess care quality, including individual patients’ outcomes, attention to patients’ needs, and unintended consequences such as effects on access to services. The Secretary would choose appropriate criteria for each model. Another amendment would add language requiring appropriateness to quality outcomes for the medical conditions under study, but the full provision being amended is not supplied.
the quality of care furnished under the model, including the measurement of patient-level outcomes, patient-centeredness, and any unintended consequences, such as access to services, using criteria determined appropriate by the Secretary for each model
in subparagraph (C), by striking and before patient-centered care and inserting , are appropriate to issues of quality outcomes related to the medical conditions under study, and are.
Within 12 months after enactment, the Comptroller General would have to report to Congress on the Center’s efforts to attract, retain, and develop emerging experts; the impact of its existing authority to address workforce shortages and gaps in priority areas; and how its legal authority compares with the Secretary’s authority under a specified 1967 law.
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 that contains an analysis of— (1) the efforts of the Center for Medicare and Medicaid Innovation to attract, retain, and develop emerging experts; (2) the impact of the existing authority provided to the Center for Medicare and Medicaid Innovation to address workforce shortages and gaps in priority areas; and (3) the similarities and differences between the authority provided to the Center for Medicare and Medicaid Innovation under section 1115A of the Social Security Act (42 U.S.C. 1315a) and the authority provided to the Secretary of Health and Human Services under section 402 of the Social Security Amendments of 1967 (42 U.S.C. 1395b–1).
Unless a section specifies otherwise, the amendments would apply to model testing, expansion, or modification on or after January 1, 2027. The congressional review and judicial review amendments expressly would apply beginning at enactment.
Except as otherwise provided in the previous sections of this Act (and 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, 2027.
The amendments made by this section shall apply beginning on the date of the enactment of this Act.
The amendments made by this section shall apply beginning on the date of the enactment of this Act.
The supplied official-actions snapshot, updated October 14, 2026, records introduction in the House on October 1, 2026, and referral that day to Energy and Commerce, Ways and Means, and Rules. This snapshot does not establish subsequent action or enactment.
Source snapshot updated 2026-10-14T15:15:25Z.
2026-10-01: Introduced in House
2026-10-01: 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 jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2026-10-01. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy change attached to appropriations was identified after reviewing the complete supplied introduced text. This conclusion is limited to that version and does not establish the absence of riders in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places was identified after reviewing the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials. Formal earmark status cannot be independently assessed without the missing disclosures and related materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Findings to examine
One conditional exception warrants a targeted-benefit finding in the supplied introduced text. This classification does not imply that the exception is unjustified.
Section 3(c) would create a conditional route for applicable providers and suppliers to request a waiver from any model requirement when the Secretary determines that the requirement would cause undue economic hardship to the provider or supplier or loss of access to services or supplies for vulnerable populations. The potential beneficiaries are providers and suppliers meeting those conditions, with protection of vulnerable populations’ access as an alternative basis for relief. This is a targeted exception to the model requirements governed by the bill’s main policy, rather than an unrelated provision. The text requires a plan permitting waiver requests; it does not guarantee approval of a request.
Not later than 60 days after the enactment of the Strengthening Innovation in Medicare and Medicaid Act, the Secretary shall develop and implement a plan to allow applicable providers of services or supplies 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 healthcare services or supplies for vulnerable populations.
Full text preserved for this analysis. Legislative record snapshot: Oct 14, 2026. How PlainBill uses AI