[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9336 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9336

To amend title XIX of the Social Security Act to require States to take 
  into account performance when assigning individuals to managed care 
                  entities under the Medicaid program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 18, 2026

   Mr. Goldman of Texas (for himself and Mr. Pfluger) 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 States to take 
  into account performance when assigning individuals to managed care 
                  entities 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 ``Better Care, Better Cost Act''.

SEC. 2. REQUIRING STATES TO TAKE INTO ACCOUNT PERFORMANCE WHEN 
              ASSIGNING INDIVIDUALS TO MANAGED CARE ENTITIES UNDER THE 
              MEDICAID PROGRAM.

    (a) In General.--Section 1932(a)(4) of the Social Security Act (42 
U.S.C. 1396u-2(a)(4)) is amended---
            (1) in subparagraph (D)(ii)(II), by striking ``the 
        equitable'' and all that follows through the period and 
        inserting ``the performance score of such entities, as 
        determined under the system established by the State under 
        subparagraph (E).''; and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Performance.--
                            ``(i) In general.--A State shall--
                                    ``(I) establish a system to 
                                evaluate the performance of managed 
                                care entities participating under the 
                                State plan (or wavier of such plan) of 
                                such State; and
                                    ``(II) on an annual basis, publish 
                                a report--
                                            ``(aa) evaluating the 
                                        differences in default 
                                        enrollments made taking into 
                                        account the performance scores 
                                        of managed care entities under 
                                        this subparagraph compared to 
                                        such enrollments that would 
                                        have been made had such scores 
                                        not been taken into account; 
                                        and
                                            ``(bb) quantifying any 
                                        estimated reduction in 
                                        expenditures under such plan 
                                        (or waiver) attributable to 
                                        taking into account such scores 
                                        in default enrollments.
                            ``(ii) Score.--Under the system established 
                        by a State under clause (i), the State shall 
                        assign a performance score for each managed 
                        care entity described in such clause based on 
                        such cost and outcome measures and such 
                        individual satisfaction measures as determined 
                        appropriate by the State. Measures used under 
                        such system may include, with respect to 
                        individuals enrolled under such entity, 
                        measures of the performance of such entity 
                        (compared to the risk-adjusted expected 
                        performance of such entity) with respect to the 
                        following:
                                    ``(I) Expenditures for medical 
                                assistance.
                                    ``(II) Potentially avoidable 
                                hospital readmissions.
                                    ``(III) Potentially avoidable 
                                emergency department visits.
                                    ``(IV) Potentially avoidable 
                                hospital admissions.
                                    ``(V) Satisfaction scores from such 
                                individuals and the rate at which such 
                                individuals elect to terminate 
                                enrollment with such entity.''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to the enrollment of individuals in managed care 
entities under a State plan under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.), or under a waiver of such plan, on or after 
January 1, 2028.
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