H.R. 7145

[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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