Requiring the Center for Medicare and Medicaid Innovation to test a model to improve outcomes for patients with chronic diseases by using accountable produce is medicine

Section 1115A of the Social Security Act (42 U.S.C. 1315a) is amended—(1)in subsection (b)(2)(A), in the third sentence, by inserting , and, beginning not later than the date that is 180 days after the enactment of the Accountable Produce is Medicine Act of 2026, shall include the Accountable Produce is Medicine Bundled Payment Model described in subsection (h) before the period at the end; and(2)by adding at the end the following new subsection:

(h)

Accountable Produce is Medicine Bundled Payment Model

(1)

In general

For purposes of subsection (b)(2)(A), the Accountable Produce is Medicine Bundled Payment Model (in this subsection, referred to as the model) described in this subsection is a model under which a bundled payment is made under title XVIII, title XIX, or title XXI, as appropriate, for selected programs to furnish Accountable Produce is Medicine services to eligible individuals.(2)

Selection of programs to participate

(A)

Selected programs

The Secretary shall select to participate in the model at least 5 eligible programs, each to participate for a period of not less than 2 years, that the Secretary determines have the capacity to satisfy the requirements described in paragraph (3). In this subsection, each such eligible program so selected shall be referred to as a selected program.(B)

Priority

In selecting eligible programs under subparagraph (A), the Secretary shall give priority to any such program that furnishes (including through an arrangement with a provider of services or supplier or other entity) fresh, frozen, or minimally processed fruits and vegetables without added sugars, sodium, or saturated fats (except those occurring naturally), and other plant-based, nutrient-dense foods, including nuts, seeds, intact whole grains, beans, and lentils.(3)

Minimum program requirements

Under the model, a selected program shall comply with each of the following requirements:(A)

Screening

The selected program shall screen individuals who are referred to the program by a physician, hospital, or other health care provider, to determine whether such individuals are eligible individuals.(B)

Accountable Produce is Medicine services

In the case of an individual who is determined by the selected program under subparagraph (A) to be an eligible individual, the selected program shall, for the 1-year period following such determination (subject to subparagraph (D)), make available (including through an arrangement with a provider of services or supplier or other entity) to such individual the following services (in this subsection referred to as Accountable Produce is Medicine services or APIM services):(i)A personalized health risk assessment and personalized prevention plan.(ii)Care coordination services.(iii)Telehealth services related to chronic disease monitoring, education, and follow-up.(iv)Remote patient monitoring items and services that are clinically appropriate for monitoring chronic disease and facilitating a timely response from a provider in the case that the selected program detects significant changes in the data being monitored.(v)Lifestyle modification programs, including nutrition counseling provided by a registered dietician or other qualified provider, exercise programs, and smoking cessation counseling.(vi)Healthy, nutrient-dense foods meeting such standards as the Secretary shall determine, with preference given to produce grown within 250 miles of the selected program or through the use of regenerative agriculture.(C)

Collection of health data; reenrollment assessment

In the case of an individual who is determined by the selected program under subparagraph (A) to be an eligible individual, the selected program shall—(i)track the APIM services that the individual has received from the program under the model;(ii)regularly evaluate the individual’s engagement with the program and adherence to program requirements;(iii)on a quarterly basis collect from such individual updated weight, blood pressure, and blood glucose measurements, and any other measurements determined appropriate by the Secretary; and(iv)at the end of the 1-year period described in subparagraph (B)—(I)evaluate the measurements collected under clause (iii);(II)submit to the Secretary such data as the Secretary determines necessary for purposes of evaluating the health care cost savings achieved for such individual during such period; and(III)provide for an additional determination under subparagraph (A) as to whether such individual remains an eligible individual.(D)

Disenrollment

In the case of an individual who is determined by the selected program under subparagraph (A) to be an eligible individual, if the selected program determines (in accordance with standards established by the Secretary) before the end of the 1-year period described in subparagraph (B) that such individual is not adequately engaging with the program or is not adhering to program requirements, the selected program shall terminate the individual’s participation in the program and may not furnish any additional APIM services to such individual under the model.(4)

Payment

(A)

In general

The Secretary shall determine the form, manner, and amount of bundled payment to be provided to selected programs under the model and, beginning in the third year in which such model is carried out, may require that selected programs assume financial risk for performance under the model.(B)

Cost sharing

APIM services furnished by a selected program to an eligible individual shall be provided without application of deductibles, copayments, coinsurance, or other cost-sharing under the applicable title.(5)

Duration

The model shall be carried out for a period of not less than 5 years.(6)

Definitions

In this subsection:(A)

Eligible individual

The term eligible individual means an individual—(i)who is—(I)entitled to benefits under part A of title XVIII or enrolled for benefits under part B of such title;(II)enrolled under a State plan (or waiver of such plan) under title XIX; or(III)enrolled under a State child health plan (or waiver of such plan) under title XXI;(ii)who resides in a medically underserved area (as designated pursuant to section 330(b)(3)(A) of the Public Health Service Act), a rural area (as defined in section 1886(d)(2)(D)), a health professional shortage area described in section 332(a)(1)(A) of the Public Health Service Act, or another area determined appropriate by the Secretary;(iii)who has diabetes, obesity, cardiovascular disease, hypertension, malnutrition, or any other disease or chronic condition that the Secretary determines appropriate;(iv)in the clinical judgment of a physician or other health care professional, who would benefit from participation in the model;(v)who the eligible program determines to be prepared to participate in the model; and(vi)who is not already receiving items or services that the Secretary determines are substantially similar (and duplicative in purpose and clinical function) to the APIM services described in clause (v) of paragraph (3)(B).(B)

Eligible program

The term eligible program means a provider of services (as defined in section 1861(u)) or supplier enrolled in the program under title XVIII, title XIX, or title XXI.(C)

Regenerative agriculture

The term regenerative agriculture means a conservation management approach that emphasizes natural resources through improved soil health, water management, and natural vitality.(D)

Supplier

The term supplier means a physician or other practitioner, a facility, or other entity that furnishes services under title XVIII, title XIX, or title XXI.