[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7145 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 7145
To amend title XIX of the Social Security Act to establish a definition
of essential health system in statute and for other related purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 16, 2026
Mrs. Trahan (for herself, Mr. Valadao, Mr. Ciscomani, Mr. Carter of
Louisiana, Mr. Veasey, and Mr. Soto) 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 establish a definition
of essential health system in statute and for other related purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. ESTABLISHING A DEFINITION OF ESSENTIAL HEALTH SYSTEM IN
STATUTE.
(a)(1) In General.--Section 1905 of the Social Security Act (42
U.S.C. 1396d) is amended by adding at the end the following new
subsection:
``(ll) Essential Health System.--The term `essential health system'
means a hospital--
``(1)(A) that is a subsection (d) hospital (as defined in
section 1886(d)(1)(B));
``(B) that is a non-Federal governmental or private
nonprofit hospital; and
``(C) that met one of the following three criteria in at
least two of the three most recent fiscal years, demonstrating
the hospital provides a high-volume of care to Medicaid and
other low-income patients:
``(i) Medicaid and low-income medicare criteria.--
``(I) The hospital had a Medicare
disproportionate patient percentage of at least
35 percent (as defined in section
1886(d)(5)(F)(vi)).
``(ii) Uncompensated care criteria.--
``(I) The hospital had a Medicare
disproportionate share hospital uncompensated
care payment factor of 0.0005 or more (as
defined in section 1886(r)(2)(C)).
``(iii) State-adjusted low-income care criteria.--
``(I) The hospital had a value for the
criteria described in clause (i) or clause (ii)
that is in the top 16th percentile for
subsection (d) hospitals (as defined in section
1886(d)(1)(B)) in the state in which it is
located.
In determining whether a hospital meets at least one of
the criteria specified in subparagraph (C), the
Secretary shall utilize data published with the final
rules revising the Medicare inpatient prospective
payment systems for the three most recent fiscal years.
``(2) Period of designation.--The designation of an
essential health system under paragraph (1) shall be effective
for a period of 5 years, provided the hospital continues to
meet the criteria in subparagraphs (A) and (B) in each year,
and shall be subject to redesignation thereafter under
paragraph (1) for five year periods thereafter.''.
(b) Essential Health System Designation and Index.--Section 1900(b)
of the Social Security Act (42 U.S.C. 1396(b)) is amended--
(1) by redesignating paragraphs (7) through (14) as
paragraphs (8) through (15) respectively; and
(2) by inserting after paragraph (6) the following:
``(7) Essential health system index.--
``(A) Not later than six months after the date of
enactment and by August 1st in each year thereafter,
MACPAC shall--
``(i) Prepare and submit to Congress a list
of essential health systems that meet the
criteria specified in section1905(ll),
including hospitals newly meeting the criteria
and those that were so designated in one of the
previous four fiscal years; and
``(ii) Establish and publish essential
health system index values for each hospital
that is a subsection (d) hospital (as defined
in section 1886(d)(1)(B)) in accordance with
subparagraph (B).
``(B) In this subparagraph, the term `essential
health system index value' is a computation of each
hospital's percentile ranking for the most recent
fiscal year for which data is available on the measures
described in section1905(ll)(1)(C)(i) and (ii) compared
to other subsection (d) hospitals in the:
``(i) same core-based statistical area (if
applicable),
``(ii) same state, and
``(iii) nationally.
``(C) MACPAC shall report these values individually
and shall also report a composite index value
calculated as the average of the individual index
values specified in subparagraph (B).''.
(c) MACPAC Agenda.--Section 1900(b)(2)(A) of the Social Security
Act (42 U.S.C. 1396(b)(2)(A)) is amended--
(1) in clause (ii), by striking ``and'' at the end;
(2) in clause (iii), by striking the period at the end and
inserting ``; and'' at the end; and
(3) by adding at the end the following new clause:
``(iv) payment policies that use the
criteria described in subparagraph (b)(7) to
provide targeted support for essential health
systems and ensure access to the essential
community services that they provide.''.
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