To amend title XIX of the Social Security Act to establish a definition of essential health system in statute and for other related purposes.
Summary
What This Bill Does
This bill amends title XIX of the Social Security Act to define an essential health system. A hospital qualifies if it is a subsection (d) hospital, is non-federal governmental or private nonprofit, and in at least two of the three most recent fiscal years meets one of three low-income-care tests: a Medicare disproportionate patient percentage of at least 35 percent, a Medicare disproportionate share hospital uncompensated-care payment factor of at least 0.0005, or a State top-16th-percentile value on one of those measures. The Secretary must use data published with the final Medicare inpatient prospective payment system rules. Designation lasts five years if the hospital continues to meet the basic hospital and ownership criteria and can be renewed. The bill also requires MACPAC, within six months and by August 1 each year after that, to submit to Congress a list of essential health systems, including newly qualifying hospitals and hospitals designated in one of the prior four fiscal years. MACPAC must publish index values ranking each subsection (d) hospital by the relevant low-income and uncompensated-care measures in the same core-based statistical area, State, and nation, plus a composite average. MACPAC must also include payment policies using those criteria to target support for essential health systems and preserve essential community services.
Who Benefits and How
Public hospitals, private nonprofit safety-net hospitals, high-Medicaid hospitals, hospitals with high Medicare DSH percentages, hospitals with uncompensated-care payment factors of at least 0.0005, and hospitals in the top State percentile for low-income care benefit from a statutory designation that can support targeted Medicaid and Medicare payment-policy arguments. Medicaid patients, low-income Medicare patients, uninsured patients, and communities relying on essential community services benefit if the designation helps preserve access. MACPAC and Congress benefit from annual lists and comparative index values.
Who Bears the Burden and How
MACPAC staff must collect data, publish annual hospital index values, calculate core-based statistical area, State, national, and composite rankings, and report to Congress. HHS and CMS staff must interpret the new definition using Medicare inpatient prospective payment system data and may need to align payment-policy analysis with the designation. Hospitals seeking designation must monitor three-year qualification data and five-year redesignation status. Federal and State budget officials may face pressure to target payment support to qualifying hospitals.
Key Provisions
- Defines essential health system hospitals as qualifying subsection (d), non-federal governmental or private nonprofit hospitals.
- Requires qualification through Medicare DSH percentage, uncompensated-care payment factor, or State top-16th-percentile low-income-care measures.
- Provides a five-year designation period with redesignation if criteria continue to be met.
- Requires MACPAC to list essential health systems within six months and annually by August 1.
- Requires MACPAC to publish hospital index values for core-based statistical area, State, national, and composite comparisons.
- Adds payment-policy analysis using essential-health-system criteria to support essential community services.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Defines essential health system hospitals in Medicaid law, requires MACPAC to identify and rank qualifying subsection (d) hospitals each year using low-income Medicare and uncompensated-care measures, and adds targeted payment-policy analysis for essential community services.
Key Policy Areas
Healthcare, Medicaid, Hospitals
Primary Purpose
Defines essential health system hospitals in Medicaid law, requires MACPAC to identify and rank qualifying subsection (d) hospitals each year using low-income Medicare and uncompensated-care measures, and adds targeted payment-policy analysis for essential community services.
Policy Domains
Substantive provisions
Identified Gains
- Safety-net hospitals
- Public hospitals
- Private nonprofit hospitals
- Medicaid patients
- Low-income Medicare patients
- Uninsured patients
- MACPAC commissioners
Identified Costs
- MACPAC analysts
- HHS payment-policy staff
- CMS hospital payment staff
- Hospitals tracking qualification data
- Federal budget officials
- State Medicaid budget offices
Sponsors
Legislative Progress
In CommitteeReferred to the House Committee on Energy and Commerce.
Introduced in House
Mrs. Trahan (for herself, Mr. Valadao, Mr. Ciscomani, Mr. Carter …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Low-income Medicare patients, Medicaid patients, Private nonprofit hospitals
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology