New legislation calls on CMMI to create model based on health equity

New legislation in the House and Senate aims to increase the role of health equity in the development of value-based payment models, including a demand that the Biden administration create a model specifically on dual-eligible beneficiaries, behavioral health and maternal mortality.

The John Lewis Equality in Medicare and Medicaid Treatment Act, introduced Thursday by Rep. Terri Sewell, D-Alabama, aims to advance equity in the work of the Center for Medicare and Medicaid Innovation (CMMI). The legislation, a companion for which was introduced last month in the Senate, comes as addressing equity is a major priority for the center and the Biden administration. 

“The current healthcare system contains numerous disparities in health equity and access to care, a fact that has been exacerbated by the COVID-19 pandemic,” said Sen. Cory Booker, D-New Jersey, sponsor of the Senate version, in a statement.

The legislation would require CMMI to rethink how it approaches value-based care payment models, which the center oversees.

It calls for CMMI to create a new social determinants of health model that focuses specifically on “health conditions of those dually eligible for Medicaid and Medicare, behavioral health and maternal mortality,” a release on the bill said. It also would require CMMI to include experts on health disparities to participate in the evaluation and review of any new models. 

Models must also consider how they will impact access for “people of color, women and people in rural areas, in addition to cost and quality.”

The legislation comes as the Centers for Medicare & Medicaid Services (CMS) has pressed to make health equity a major priority in the development of payment models and regulations for providers and payers. For instance, CMS is exploring how to create quality measures that examine how Medicare Advantage plans address equity for beneficiaries. 

CMMI is also rethinking its approach to payment models as part of a strategic refresh rolled out last year.

The center made major changes to incorporate equity into the recently rebranded Direct Contracting model, which now goes by ACO Realizing Equity, Access and Community Health (REACH). The model, which grants fully and partially capitated payments to physicians, requires participants to develop an equity plan on how they are going to reduce disparities in care.

CMMI Director Liz Fowler has said that the equity plan requirement could become a commonplace demand in all payment models. 

CMS had not returned a request for comment on the legislation as of the time of publication.