This bill establishes a Medicare demonstration program to promote collaborative treatment of mental and physical health comorbidities, focusing on vulnerable communities and addressing social determinants of health.
Michael Bennet
Senator
CO
The "Mental and Physical Health Care Comorbidities Act of 2025" establishes a Medicare demonstration program to promote collaborative treatment for individuals with co-occurring mental and physical health conditions, addressing social determinants of health. This program, running from October 2025 to September 2030, will allow eligible hospitals to test innovative care models, share best practices, and identify potential payment reforms. The Secretary will establish a learning collaborative and report to Congress on the program's outcomes. Funding will be sourced from existing appropriations.
Medicare Kicks Off 5-Year Test: Treating Mind, Body, and Life Challenges Together Starting 2025
This legislation greenlights a five-year Medicare demonstration program, running from October 1, 2025, to September 30, 2030. The core mission? To test out fresh ways for specific hospitals—think rural facilities, large teaching hospitals, and small urban safety nets—to care for people juggling both mental and physical health conditions, known as comorbidities. Crucially, the program also requires tackling related life challenges, often called 'social determinants of health,' like housing instability or lack of transportation, that can significantly impact well-being.
Bridging the Gaps: What This Program Tries to Do
Let's break down what 'comorbidities' and 'social determinants' mean in real terms. Imagine someone managing diabetes (physical health) while also dealing with depression (mental health). Now add the stress of unreliable transportation to get to doctor's appointments or difficulty affording healthy food – those are social determinants. This program, outlined in the new Section 1866H of the Social Security Act, pushes participating hospitals to develop 'innovations' to address this whole picture. They need to come up with a solid plan, track quality metrics, and partner with community organizations. The focus is specifically on helping vulnerable populations, including Medicare beneficiaries who also qualify for low-income subsidies, are enrolled in Medicaid, or lack insurance.
Testing, Learning, and Paying Differently
This isn't just about trying new things; it's about learning what actually works. Hospitals selected for the program will join a 'Learning Collaborative' to share their experiences and results. They'll also operate under an 'annualized payment arrangement,' though the exact details of this payment structure aren't fully spelled out in the initial text – a point worth watching as the program rolls out. The goal is to see if these integrated approaches, which treat the person rather than just isolated conditions, lead to better health outcomes and potentially smarter spending. The government, specifically the Secretary of Health and Human Services, will coordinate the effort, help identify potential long-term payment reforms for Medicare and Medicaid based on the findings, and deliver a final report card to Congress within a year of the program's end in 2030.