To amend title XIX of the Social Security Act to establish a definition of essential health system in statute and for other related purposes.

[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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