The EASE Act of 2025 would amend title XI of the Social Security Act to require the Centers for Medicare and Medicaid Innovation (CMMI) to test a Specialty Health Care Services Access Model. The model aims to deliver specialty care to eligible Medicare and Medicaid beneficiaries through networks of providers that use digital modalities, coordinated with patients’ primary care providers.
The Secretary would select qualifying provider networks—nonprofit entities with rural health experience—capable of data collection, exchange, and evaluation to support the model. Funding for the model is constrained by existing Public Health Service Act program spending rules.
At a Glance
What It Does
The bill creates a Specialty Health Care Services Access Model within 1115A that the Secretary can implement by entering into agreements with provider networks to furnish specialty services to eligible individuals via telehealth and other digital modalities.
Who It Affects
Eligible Medicare beneficiaries (Part A or Part B) and Medicaid/CHIP enrollees located in rural or underserved areas, plus the networks and providers that participate.
Why It Matters
It signals a federal effort to expand access to specialty services where geographic barriers and provider shortages are most acute, using telehealth to connect patients with specialists.
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What This Bill Actually Does
The EASE Act of 2025 adds a new demonstration model to the list of options under the CMS Innovation Center. This Specialty Health Care Services Access Model would allow the Secretary to contract with one or more nonprofit provider networks to deliver specialty health services to eligible beneficiaries in rural or underserved areas, using digital tools such as telehealth.
Networks must include at least 50 sites—drawn from Federally Qualified Health Centers, Rural Health Clinics, Critical Access Hospitals, or Rural Emergency Hospitals—with at least half located in rural areas. They must be nonprofit (501(c)(3)) and have a proven track record of serving rural or underserved communities across multiple regions, and they must be capable of data collection and exchange to support the model’s evaluation.
Eligible beneficiaries include those entitled to Medicare Part A or enrolled in Part B, or those enrolled in Medicaid/CHIP who meet medical assistance eligibility AND live in rural or underserved areas. The model evinces a coordinated, provider-network approach that leverages digital health to expand access to specialty care while tying into patients’ existing primary care relationships.
Funding for the model is subject to the restrictions applicable to funds for programs authorized under sections 330–340 of the Public Health Service Act (as carried by Public Law 117-328).
The Five Things You Need to Know
The bill adds the Specialty Health Care Services Access Model to section 1115A as a new demonstration model.
Provider networks must include at least 50 sites (FQHCs, RHCs, CAHs, or rural ERHs), with at least half in rural areas.
Networks must be nonprofit (501(c)(3)) and have a proven track record delivering care in rural/underserved regions across multiple states.
Care under the model is delivered through digital modalities (telehealth and similar technologies) coordinated with beneficiaries’ primary care providers.
Funding for the model is limited by Public Law 117-328 requirements applicable to Public Health Service Act programs 330–340.
Section-by-Section Breakdown
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Amendment to add the Specialty Health Care Services Access Model
The amendment adds a reference to the Specialty Health Care Services Access Model in 1115A(b)(2)(B)(xxviii) and designates the new model as the described option for testing specialty health services access. This creates a formal hook for CMS to begin implementing a demonstrated model under the broader 1115A framework.
Specialty Health Care Services Access Model—Overview
Subsection (h) establishes a new model under which the Secretary can enter into agreements with one or more provider networks to furnish specialty health services, as specified by the Secretary, to eligible individuals using digital modalities. The model is designed to coordinate with the patients’ primary care providers to ensure integrated care delivery.
Provider Network Selection Criteria
This subsection outlines the criteria for networks that may participate: networks must be nonprofit (501(c)(3)); include at least 50 qualifying sites with at least half located in rural areas; be comprised of FQHCs, RHCs, CAHs, or rural ERHs; have demonstrated capacity to collect, exchange, and evaluate data related to the model; and have an established record of serving rural or underserved communities across multiple regions.
Eligible Individuals and Geographic Scope
Defines who counts as an eligible individual: someone entitled to Medicare Part A or enrolled in Part B, or someone enrolled in Medicaid/CHIP who meets applicable medical assistance and pregnancy-related eligibility components, and who resides in a rural or underserved area as designated by the Secretary. This aligns model participation with populations most likely to benefit from improved access to specialty care.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries in rural or underserved areas gain faster and potentially more convenient access to specialty services via telehealth and other digital modalities.
- Medicaid/CHIP enrollees who meet program eligibility and live in rural or underserved regions gain access to specialty care that may have been geographically or logistically difficult to obtain.
- Federally Qualified Health Centers, Rural Health Clinics, Critical Access Hospitals, and Rural Emergency Hospitals gain a formal pathway to deliver more comprehensive specialty services through participating networks.
- Nonprofit provider networks that meet the eligibility criteria and demonstrate capacity for data collection can expand their role in serving rural communities.
- The CMS Innovation Center and federal program policymakers have a concrete model to evaluate and scale if successful.
Who Bears the Cost
- Federal taxpayers funding the demonstration and related CMS administration costs.
- Participating nonprofit networks investing in data infrastructure, telehealth capabilities, and care coordination workflows.
- State and local health systems coordinating with the model and managing implementation at the provider level.
- Potential temporary shifts in service delivery markets as telehealth-enabled specialty services expand to new sites.
Key Issues
The Core Tension
The central tension is balancing the goal of expanding access to specialty care through telehealth-enabled networks with the costs, administrative burden, and scale required to sustain a multi-region, data-driven demonstration that preserves care quality.
The bill creates an ambitious telehealth-enabled pathway to increased access to specialty care in rural and underserved areas, but several tensions warrant attention. Real-world success will depend on assembling robust networks that can sustain the required data collection and interoperability, while also maintaining care quality and provider engagement.
The reliance on nonprofit networks could exert a selection effect, favoring entities with existing rural networks and philanthropy-driven capacity, potentially limiting broader participation. Administrative overhead for CMS and participating providers could rise as new reporting, data-sharing, and care-coordination requirements are implemented.
It is also important to consider how this model interacts with existing telehealth and waiver programs and whether it will address long-standing disparities without duplicating efforts or cannibalizing existing rural health services.
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