{"id":10516,"date":"2026-04-29T22:45:40","date_gmt":"2026-04-29T22:45:40","guid":{"rendered":"https:\/\/usatrustedlawyers.com\/blog\/election-year-politics-and-policy-at-cmmi-what-stakeholders-can-expect-polsinelli\/"},"modified":"2026-04-29T22:45:40","modified_gmt":"2026-04-29T22:45:40","slug":"election-year-politics-and-policy-at-cmmi-what-stakeholders-can-expect-polsinelli","status":"publish","type":"post","link":"https:\/\/usatrustedlawyers.com\/blog\/election-year-politics-and-policy-at-cmmi-what-stakeholders-can-expect-polsinelli\/","title":{"rendered":"Election Year Politics and Policy at CMMI: What Stakeholders Can Expect | Polsinelli"},"content":{"rendered":"\n<div id=\"html-view-content\">\n<h2 style=\"margin-top:24px; margin-bottom:5px\"><span style=\"font-weight:700; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Key Takeaways<\/span><\/span><\/h2>\n<ul>\n<li aria-level=\"1\" style=\"list-style-type:disc\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">CMS\u2019 Innovation Center is accelerating new payment and care delivery models as the Trump administration uses CMMI to advance health policy priorities. Current models target areas such as chronic care, behavioral health, drug pricing and value-based care.<\/span><\/span><\/li>\n<li aria-level=\"1\" style=\"list-style-type:disc\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">CMMI remains a powerful policy vehicle, but its recent pace has drawn renewed scrutiny over cost savings, scale and taxpayer value. That debate could shape oversight, legislation and expectations for how future models are designed and evaluated.<\/span><\/span><\/li>\n<li aria-level=\"1\" style=\"list-style-type:disc\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Health care stakeholders should continue tracking CMMI closely as participation opportunities expand and mandatory models create new operational demands. Organizations should assess where engagement, compliance planning or advocacy may be needed as models evolve.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">The Centers for Medicare &amp; Medicaid Services (CMS) is currently pursuing approximately 35 models designed to test new forms of health care delivery and payment systems to advance administration priorities while seeking to improve patient outcomes and lower overall health care system costs. Authorized by the Affordable Care Act, CMS\u2019 Innovation Center (CMMI) is tasked with drafting and implementing short-term demonstration pilots and has several announced and active models that are recruiting participants or currently underway, such as:<\/span><\/span><\/p>\n<h2 style=\"margin-top:24px; margin-bottom:5px\"><span style=\"font-weight:700; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Why have we seen a proliferation of models in this Administration?<\/span><\/span><\/h2>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">CMMI provides an avenue to advance the Trump administration\u2019s innovation priorities and Make America Healthy Again (MAHA) agenda relatively quickly. Agency officials have regulatory flexibility to execute and study new service arrangements without seeking congressional line-item approval for individual initiatives \u2014 a particular advantage given tight margins in the U.S. House and Senate.<\/span><\/span><\/p>\n<h2 style=\"margin-top:24px; margin-bottom:5px\"><span style=\"font-weight:700; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">How does Congress feel about CMMI\u2019s recent pace of activity?<\/span><\/span><\/h2>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">The reception has been mixed on both sides of the aisle. Current CMMI models tackle policy areas that have general bipartisan appeal, like lowering drug prices, integrating primary and behavioral health care and mainstreaming health tech to empower patients.<\/span><\/span><\/p>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">However, some Republicans have questioned CMMI\u2019s effectiveness and overall taxpayer value. A <\/span><\/span><a href=\"https:\/\/www.cbo.gov\/publication\/59274\" rel=\"nofollow noopener\" target=\"_blank\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">2023 report<\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> by the Congressional Budget Office found that from 2011 to 2020, CMMI increased direct spending by $5.4 billion \u2014 meaning that it cost more to operate the models than the savings they generated. Last month, the Government Accountability Office published an <\/span><\/span><a href=\"https:\/\/www.gao.gov\/products\/gao-26-107953\" rel=\"nofollow noopener\" target=\"_blank\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">analysis<\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> requested by the House Budget Committee that concluded only four of the 70 models that CMMI had tested between 2011 and 2024 were scaled for nationwide implementation. House Budget Committee Chairman Jodey Arrington (R-Texas) described the 5% success rate as \u201ca failure,\u201d but also commented on the importance of CMMI\u2019s overall mission and need for better accountability. One Republican member of Congress even introduced <\/span><\/span><a href=\"https:\/\/www.congress.gov\/bill\/119th-congress\/house-bill\/8293\/text\/ih?overview=closed&amp;format=xml\" rel=\"nofollow noopener\" target=\"_blank\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">legislation<\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> to abolish CMMI altogether.<\/span><\/span><\/p>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Despite this renewed scrutiny, other lawmakers still recognize CMMI as a policymaking lever. A recently introduced <\/span><\/span><a href=\"https:\/\/www.congress.gov\/bill\/119th-congress\/house-bill\/8355\/text\/ih\" rel=\"nofollow noopener\" target=\"_blank\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">bipartisan bill<\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> would require the Center to test a new bundled payment model that integrates the \u201cfood is medicine\u201d approach into caring for patients with chronic diseases by focusing on nutrition services.<\/span><\/span><\/p>\n<h2 style=\"margin-top:24px; margin-bottom:5px\"><span style=\"font-weight:700; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">What has been the response from model participants?<\/span><\/span><\/h2>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">These models can present both opportunities and challenges. For example, MAHA ELEVATE has a broad eligibility category ranging from private medical practices to academic organizations, government entities and even senior living communities. The ACCESS Model has been popular, and CMS recently announced that more than 150 health care organizations have been accepted to participate, and CMS is extending the initial application deadline to May 15.<\/span><\/span><\/p>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">In at least one instance, CMMI has had to shift its approach in response to industry pushback. The BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model intended for CMS to negotiate lower prices for GLP-1 drugs directly with manufacturers on behalf of state Medicaid agencies and Part D plans. Reluctance from health insurers led the agency to expand the <\/span><\/span><a href=\"https:\/\/www.cms.gov\/medicare\/coverage\/prescription-drug-coverage\/medicare-glp-1-bridge\" rel=\"nofollow noopener\" target=\"_blank\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Medicare GLP-1 Bridge<\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> program instead.<\/span><\/span><\/p>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">In addition, models that require participation, like the <\/span><\/span><a href=\"https:\/\/www.cms.gov\/priorities\/innovation\/innovation-models\/asm\" rel=\"nofollow noopener\" target=\"_blank\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Ambulatory Specialty Model<\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> and <\/span><\/span><a href=\"https:\/\/www.cms.gov\/priorities\/innovation\/innovation-models\/team-model\" rel=\"nofollow noopener\" target=\"_blank\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Transforming Episode Accountability Model<\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">, also carry additional considerations. Mandated participation creates administrative burdens, and competing obligations might make it harder to isolate which interventions actually lead to better patient outcomes.<\/span><\/span><\/p>\n<h2 style=\"margin-top:24px; margin-bottom:5px\"><span style=\"font-weight:700; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Is CMMI here to stay? How should my organization be thinking about CMMI?<\/span><\/span><\/h2>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Shutting down or zeroing out CMMI in this climate would require an act of Congress and potentially a presidential veto override \u2014 both of which are highly unlikely given the Trump Administration\u2019s commitment to using CMMI as a policy tool. Additionally, the second half of a president\u2019s term typically marks a greater reliance on existing executive authority, rulemaking and guidance to achieve goals. We therefore would expect CMMI to continue featuring prominently in the administration\u2019s health care roadmap, especially if the midterm elections lead to divided government and the end of unilateral Republican control over the White House, U.S. House and Senate.<\/span><\/span><\/p>\n<p>[<a href=\"https:\/\/www.polsinelli.com\/publications\/election-year-cmmi-policy-stakeholder-outlook\" target=\"_blank\" rel=\"nofollow noopener\">View source<\/a>.]<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Key Takeaways CMS\u2019 Innovation Center is accelerating new payment and care delivery models as the Trump administration uses CMMI to advance health policy priorities. Current models target areas [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":10517,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[7865,642,218,1775,7864,2672,7866,656],"class_list":["post-10516","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lawyers","tag-cmmi","tag-election","tag-expect","tag-policy","tag-politics","tag-polsinelli","tag-stakeholders","tag-year"],"_links":{"self":[{"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/posts\/10516","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/comments?post=10516"}],"version-history":[{"count":0,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/posts\/10516\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/media\/10517"}],"wp:attachment":[{"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/media?parent=10516"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/categories?post=10516"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/tags?post=10516"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}