The Ensuring Access to Specialty Care Everywhere Act (EASE Act) would require the Centers for Medicare and Medicaid Innovation (CMMI) to test a Specialty Health Care Services Access Model under Section 1115A of the Social Security Act. The model would allow the Secretary to enter into agreements with one or more provider networks to furnish specialty health care services to eligible individuals through digital modalities (telehealth and other remote technologies) coordinated with patients’ primary care providers.
The bill also defines the network criteria and the group of beneficiaries eligible for the model, emphasizing rural and underserved areas.
Key design features include selecting networks that meet specific structure and capability requirements and restricting funding to align with existing HRSA-funded programs under the Public Health Service Act. If enacted, the model would operate as a pilot within Medicare and Medicaid, focusing on improving access to specialty services where travel and specialist shortages limit timely care.
At a Glance
What It Does
The bill adds a Specialty Health Care Services Access Model (SHCSAM) to Section 1115A. CMS would enter into agreements with provider networks to deliver specialty services to eligible individuals via digital modalities, in coordination with primary care providers.
Who It Affects
Provider networks such as FQHCs, RHCs, CAHs, and rural hospitals that participate; rural and underserved Medicare and Medicaid beneficiaries who will access specialty care remotely.
Why It Matters
This model explicitly targets geographic access gaps, attempting to move specialty care closer to patients in rural areas through telehealth and coordinated primary care, with data-sharing expectations to evaluate outcomes.
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What This Bill Actually Does
The EASE Act would add a new Specialty Health Care Services Access Model to the existing 1115A framework. Under this model, the Secretary would select one or more provider networks to furnish specialty health services to eligible individuals using telehealth and other remote technologies.
These networks must meet defined criteria and be able to collect and exchange data to support the model’s operation and evaluation. Eligibility is limited to individuals who are Medicare Part A or Part B beneficiaries or Medicaid/CHIP beneficiaries who live in rural or underserved areas and meet traditional eligibility requirements.
The networks chosen would need to include at least 50 facilities such as FQHCs, RHCs, or CAHs, with at least half located in rural regions. They must be nonprofit (501(c)(3)), have a proven record of serving rural or underserved communities across multiple regions, and possess the capability to collect, exchange, and evaluate data related to the model.
Funding for the initiative would be governed by the same statutory framework that applies HRSA programs 330–340, as amended by Public Law 117-328, ensuring alignment with existing federal health service funding rules.Eligibility is targeted, focusing on rural or underserved patients who are entitled to Medicare benefits or enrolled in Medicaid/CHIP and who reside in those areas. The model is designed to operate through digital channels—in coordination with patients’ primary care providers—to improve access to needed specialty services without requiring patients to travel to distant urban centers.
The Five Things You Need to Know
The bill creates a Specialty Health Care Services Access Model (SHCSAM) under Section 1115A to test telehealth-based specialty care delivery.
, The model requires networks of at least 50 facilities (FQHCs/RHCs/CAHs), with at least half in rural areas, and mandates nonprofit status and proven rural outreach experience.
, Eligible individuals include Medicare Part A/B enrollees and Medicaid/CHIP beneficiaries located in rural or underserved areas, as defined by the bill and Secretary's guidance.
Section-by-Section Breakdown
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Amendment to include SHCS Access Model
The bill amends Section 1115A to add the Specialty Health Care Services Access Model as a defined option under the existing demonstration authority. It embeds the SHCSAM within the broader framework of reforms that CMS can test, linking it to use of digital modalities to deliver specialty care and to coordinate with patients’ primary care providers.
Specialty Health Care Services Access Model
Section 1115A is augmented with a new subsection (h) that defines the SHCSAM. It establishes the model’s purpose (to furnish specialty services via digital modalities to eligible individuals) and sets the structural requirements for how the model operates, who can participate, and how data will be used to assess outcomes.
Provider Network Selection Criteria
The Secretary shall select one or more provider networks to carry out the model. Networks must include at least 50 FQHCs, RHCs, or CAHs, with at least half located in rural areas. Networks must be nonprofit (501(c)(3)) and have a documented history of serving rural or underserved communities across multiple regions, and must be capable of data collection, exchange, and evaluation related to the model.
Eligible Individual Definition
For purposes of the SHCSAM, an eligible individual is someone entitled to Medicare Part A or enrolled under Part B, or someone enrolled in Medicaid or CHIP who meets applicable medical assistance and pregnancy-related eligibility criteria and resides in a rural or underserved area as defined by the Secretary.
Funding Limitations and Applicability
Any funding to support the amendments must comply with Public Law 117-328’s requirements for HRSA programs (sections 330–340). This ties the SHCSAM funding to existing federal program rules, ensuring consistency with other community health initiatives and avoiding unfunded expansions.
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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
- Rural Medicare and Medicaid beneficiaries who gain access to needed specialty services through telehealth and closer coordination with primary care providers.
- FQHCs, RHCs, and CAHs in rural areas that join the SHCSAM networks and can extend specialty care access to their patient populations.
- Rural primary care physicians who can coordinate care with remote specialists without requiring patient travel.
- Specialists who participate in the SHCSAM networks and can reach underserved patient populations via telehealth.
Who Bears the Cost
- Federal funding for the SHCSAM, governed by HRSA-related funding rules in Public Law 117-328.
- Participating provider networks that may incur upfront and ongoing costs to establish telehealth infrastructure, data exchange capabilities, and care coordination workflows.
- CMS/CMMI oversight and evaluation costs associated with piloting and assessing the SHCSAM.
- Potential administrative costs for states and health systems implementing the eligibility and enrollment processes within their Medicaid programs.
Key Issues
The Core Tension
Balancing the pursuit of broader rural access through telehealth with the need to maintain care quality, data integrity, and sustainable funding within a pilot framework.
The SHCSAM presents a clear avenue to expand access to specialty care for rural populations, but it hinges on the ability of provider networks to invest in telehealth infrastructure and data-sharing capabilities. Implementation across diverse rural contexts could pose challenges for standards of care, privacy and security of health information, and the interoperability of data systems.
The model may also face practical constraints related to patient eligibility verification, coordination with primary care, and sustained funding beyond initial pilots. Additionally, by tying funding to HRSA program rules, the bill reduces the risk of unfunded mandates but may limit flexibility in how the model scales or adapts to state Medicaid variations.
coreTension: The central challenge is balancing ambitious access expansion through telehealth with the realities of network readiness, data interoperability, and long-term financing. While SHCSAM aims to reach underserved communities, ensuring consistent quality of care across networks and maintaining patient privacy in a digital environment will require robust governance and ongoing evaluation.
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