[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8113 Introduced in House (IH)]

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118th CONGRESS
  2d Session
                                H. R. 8113

 To amend title XIX of the Social Security Act to require reporting on 
         certain directed payments under the Medicaid program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 23, 2024

 Mr. Griffith introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend title XIX of the Social Security Act to require reporting on 
         certain directed payments under the Medicaid program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Transparency into State Directed 
Payments Act of 2024''.

SEC. 2. STATE DIRECTED PAYMENT REPORTING REQUIREMENTS.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection:
    ``(cc) State Directed Payment Reporting Requirements.--
            ``(1) Collection and availability of directed payment 
        data.--
                    ``(A) In general.--Not later than January 1, 2026, 
                the Secretary shall establish a system for each State 
                to submit a report, at intervals as determined 
                appropriate by the Secretary, on directed payment data, 
                as a requirement for a State plan or a State plan 
                amendment that would provide for a directed payment 
                arrangement.
                    ``(B) Requirements.--Each report submitted by a 
                State in accordance with the requirement established 
                under subparagraph (A) shall include the following:
                            ``(i) An explanation of how directed 
                        payments made under the State plan or a State 
                        plan amendment will result in payments that are 
                        consistent with section 1902(a)(30)(A), 
                        including standards with respect to efficiency, 
                        economy, quality of care, and access, along 
                        with the stated purpose and intended effects of 
                        the directed payment.
                            ``(ii) The criteria used to determine which 
                        providers are eligible to receive the directed 
                        payment.
                            ``(iii) A comprehensive description of the 
                        methodology used to calculate the amount of, 
                        and distribute, the directed payment to each 
                        eligible provider, including--
                                    ``(I) data on the amount of the 
                                directed payment made to each eligible 
                                provider, if known, or, if the total 
                                amount is distributed using a formula 
                                based on data from 1 or more fiscal 
                                years, data on the total amount of the 
                                directed payments for the fiscal year 
                                or years available to all providers 
                                eligible to receive a directed payment;
                                    ``(II) if applicable, the specific 
                                criteria with respect to Medicaid 
                                service, utilization, or cost data to 
                                be used as the basis for calculations 
                                regarding the amount or distribution of 
                                the directed payment; and
                                    ``(III) the timing of the directed 
                                payment made to each eligible provider.
                            ``(iv) An analysis of how total Medicaid 
                        payments made to an eligible provider, 
                        including the directed payment, compare 
                        relative to the upper payment limit for such 
                        provider and the average commercial rate for 
                        the services to which the payment relates.
                            ``(v) The net payment rate to a provider 
                        receiving a directed payment that is inclusive 
                        of base payment rates, supplemental payments 
                        (as defined in subsection (bb)), and any such 
                        directed payments.
                    ``(C) Public availability.--The Secretary shall 
                make all reports and related data submitted under this 
                paragraph publicly available on the website of the 
                Centers for Medicare & Medicaid Services on a timely 
                basis.
            ``(2) Definitions.--In this subsection:
                    ``(A) Directed payment arrangement.--The term 
                `directed payment arrangement' means a contract 
                arrangement between a State and a managed care 
                organization, prepaid ambulatory health plan, or 
                prepaid inpatient health plan that directs the 
                expenditures of such managed care organization, prepaid 
                ambulatory health plan, or prepaid inpatient health 
                plan in a manner allowable under section 438.6 of title 
                42, Code of Federal Regulations (or any successor 
                regulation).
                    ``(B) Directed payment.--The term `directed 
                payment' means a payment to a provider made pursuant to 
                a directed payment arrangement.
                    ``(C) Prepaid ambulatory health plan; prepaid 
                inpatient health plan.--The terms `prepaid ambulatory 
                health plan' and `prepaid inpatient health plan' have 
                the meaning given each such term in section 438.2 of 
                title 42, Code of Federal Regulations (or any successor 
                regulation).''.
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