[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8113 Introduced in House (IH)]
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118th CONGRESS
2d Session
H. R. 8113
To amend title XIX of the Social Security Act to require reporting on
certain directed payments under the Medicaid program.
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IN THE HOUSE OF REPRESENTATIVES
April 23, 2024
Mr. Griffith introduced the following bill; which was referred to the
Committee on Energy and Commerce
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A BILL
To amend title XIX of the Social Security Act to require reporting on
certain directed payments 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 ``Transparency into State Directed
Payments Act of 2024''.
SEC. 2. STATE DIRECTED PAYMENT REPORTING REQUIREMENTS.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended by adding at the end the following new subsection:
``(cc) State Directed Payment Reporting Requirements.--
``(1) Collection and availability of directed payment
data.--
``(A) In general.--Not later than January 1, 2026,
the Secretary shall establish a system for each State
to submit a report, at intervals as determined
appropriate by the Secretary, on directed payment data,
as a requirement for a State plan or a State plan
amendment that would provide for a directed payment
arrangement.
``(B) Requirements.--Each report submitted by a
State in accordance with the requirement established
under subparagraph (A) shall include the following:
``(i) An explanation of how directed
payments made under the State plan or a State
plan amendment will result in payments that are
consistent with section 1902(a)(30)(A),
including standards with respect to efficiency,
economy, quality of care, and access, along
with the stated purpose and intended effects of
the directed payment.
``(ii) The criteria used to determine which
providers are eligible to receive the directed
payment.
``(iii) A comprehensive description of the
methodology used to calculate the amount of,
and distribute, the directed payment to each
eligible provider, including--
``(I) data on the amount of the
directed payment made to each eligible
provider, if known, or, if the total
amount is distributed using a formula
based on data from 1 or more fiscal
years, data on the total amount of the
directed payments for the fiscal year
or years available to all providers
eligible to receive a directed payment;
``(II) if applicable, the specific
criteria with respect to Medicaid
service, utilization, or cost data to
be used as the basis for calculations
regarding the amount or distribution of
the directed payment; and
``(III) the timing of the directed
payment made to each eligible provider.
``(iv) An analysis of how total Medicaid
payments made to an eligible provider,
including the directed payment, compare
relative to the upper payment limit for such
provider and the average commercial rate for
the services to which the payment relates.
``(v) The net payment rate to a provider
receiving a directed payment that is inclusive
of base payment rates, supplemental payments
(as defined in subsection (bb)), and any such
directed payments.
``(C) Public availability.--The Secretary shall
make all reports and related data submitted under this
paragraph publicly available on the website of the
Centers for Medicare & Medicaid Services on a timely
basis.
``(2) Definitions.--In this subsection:
``(A) Directed payment arrangement.--The term
`directed payment arrangement' means a contract
arrangement between a State and a managed care
organization, prepaid ambulatory health plan, or
prepaid inpatient health plan that directs the
expenditures of such managed care organization, prepaid
ambulatory health plan, or prepaid inpatient health
plan in a manner allowable under section 438.6 of title
42, Code of Federal Regulations (or any successor
regulation).
``(B) Directed payment.--The term `directed
payment' means a payment to a provider made pursuant to
a directed payment arrangement.
``(C) Prepaid ambulatory health plan; prepaid
inpatient health plan.--The terms `prepaid ambulatory
health plan' and `prepaid inpatient health plan' have
the meaning given each such term in section 438.2 of
title 42, Code of Federal Regulations (or any successor
regulation).''.
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