Mental and Physical Health Care Comorbidities Act of 2025
Sponsored By: Representative Boyle (PA)
Introduced
Summary
Creates a Medicare demonstration to test payment and care innovations aimed at improving outcomes for people with both mental and physical health conditions. It focuses on vulnerable communities and on tackling social drivers that worsen comorbidities.
Show full summary
- Patients and families: People with mental and physical health comorbidities and those at risk would be the focus of new care models that address social determinants of health and aim to improve outcomes. The program would run from October 1, 2025 to September 30, 2030.
- Hospitals and providers: Eligible hospitals could join by signing a participation agreement that requires a plan with quality metrics, data collection, and community partners. The Secretary would negotiate an annualized payment arrangement for each hospital, which may be a lump sum, capitation, or include financial risk options, and participants must join a learning collaborative and certify innovations supplement existing services.
- Federal policy and sharing best practices: The Secretary would identify, validate, and disseminate evidence-based models and consider Medicare and Medicaid payment reforms to scale successful approaches. The program must produce an evaluation and a report within one year after completion that details activities, populations served, social determinants addressed, outcomes, cost effects, and recommendations for legislative or administrative action.
Funding for the demonstration would come from funds appropriated under section 1115A(f) and be available to the Secretary without further appropriation.
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 6 benefits, 0 costs, 0 mixed.
How hospitals join and get paid
Hospitals that join would have to sign an agreement with the Secretary. They would submit a plan with quality measures, target groups, and community partners. The Secretary would set a yearly payment, such as a lump sum or capitation, and hospitals could take financial risk. Hospitals must join a learning group, certify new work does not replace current services, and repay if they do not follow the rules.
Medicare test for combined mental and physical care
This bill would create a Medicare test from October 1, 2025 to September 30, 2030. It would let eligible hospitals try integrated care for people with both mental and physical health needs, and those at risk. It would also support services that address social needs that harm health. You could qualify if you are a subsidy-eligible Medicare beneficiary, on Medicaid, or uninsured and live in an area served by a participating hospital. Only hospitals that meet the bill’s criteria and choose to join would offer these services.
Funding authority to run the test
If Congress provides money under section 1115A(f), HHS could use it for this test without another approval. This would not set a new dollar amount. The test would run only to the extent funds are available.
Sharing what works across hospitals
HHS would set up a Learning Collaborative. Hospitals and others would meet to share results and metrics. HHS could host focused forums by region or condition and spread effective ideas to other providers. This would also help find Medicare and Medicaid payment changes that could support wider use.
New integrated care and social help
The bill would let hospitals test new care and social supports. Examples include integrated care teams, mental health in primary care, screening for social risks, and better electronic record tracking. It would also allow home visits, telehealth, community health workers, and help with food, legal, or work needs. These services would be for eligible people in the hospital’s program.
Report on results after the test
HHS would send Congress a report within one year after the test ends. It would list each activity, who it served, and which social needs it addressed. It would show results on access, quality, costs, disparities, and more, and could include recommendations for future laws or rules.
Sponsors & CoSponsors
Sponsor
Boyle (PA)
PA • D
Cosponsors
Brown
OH • D
Sponsored 4/2/2025
Roll Call Votes
No roll call votes available for this bill.
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