[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2743 Introduced in Senate (IS)]
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119th CONGRESS
1st Session
S. 2743
To amend title XIX of the Social Security Act to modify certain
limitations on disproportionate share hospital payment adjustments
under the Medicaid program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 9, 2025
Mr. Banks (for himself and Mrs. Gillibrand) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to modify certain
limitations on disproportionate share hospital payment adjustments
under the Medicaid program, and for other purposes.
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 ``Save Our Safety-Net Hospitals Act of
2025''.
SEC. 2. MODIFYING CERTAIN LIMITATIONS ON DISPROPORTIONATE SHARE
HOSPITAL PAYMENT ADJUSTMENTS UNDER THE MEDICAID PROGRAM.
(a) In General.--Section 1923(g) of the Social Security Act (42
U.S.C. 1396r-4(g)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A)--
(i) in the matter preceding clause (i), by
striking ``(other than a hospital described in
paragraph (2)(B))'';
(ii) in clause (i), by inserting ``with
respect to such hospital and year'' after
``described in subparagraph (B)''; and
(iii) in clause (ii)--
(I) in subclause (I), by striking
``and'' at the end;
(II) in subclause (II), by striking
the period and inserting ``; and''; and
(III) by adding at the end the
following new subclause:
``(III) payments made under title
XVIII or by an applicable plan (as
defined in section 1862(b)(8)(F)) for
such services.''; and
(B) in subparagraph (B)--
(i) in the matter preceding clause (i), by
striking ``in this clause are'' and inserting
``in this subparagraph are, with respect to a
hospital and a year,''; and
(ii) by adding at the end the following new
clause:
``(iii) Individuals who are eligible for
medical assistance under the State plan or
under a waiver of such plan and for whom the
State plan or waiver is a payor for such
services after application of benefits under
title XVIII or under an applicable plan (as
defined in section 1862(b)(8)(F)), but only if
the hospital has in the aggregate incurred
costs exceeding payments under such State plan,
waiver, title XVIII, or applicable plan for
such services furnished to such individuals
during such year.'';
(2) by striking paragraph (2);
(3) by redesignating paragraph (3) as paragraph (2); and
(4) in paragraph (2), as so redesignated, by striking
``Notwithstanding paragraph (2) of this subsection (as in
effect on October 1, 2021), paragraph (2)'' and inserting
``Paragraph (2)''.
(b) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall apply to payment
adjustments made under section 1923 of the Social Security Act
(42 U.S.C. 1396r-4) for Medicaid State plan rate years
beginning on or after the date of enactment of this Act.
(2) State option to distribute unspent dsh allotments from
prior years up to modified cap.--
(A) In general.--If, for any Medicaid State plan
rate year that begins on or after October 1, 2021, and
before the date of enactment of this Act, a State did
not spend the full amount of its Federal fiscal year
allotment under section 1923 of the Social Security Act
(42 U.S.C. 1396r-4) applicable to that State plan rate
year, the State may use the unspent portion of such
allotment to increase the amount of any payment
adjustment made to a hospital for such rate year,
provided that--
(i) such payment adjustment (as so
increased) is consistent with subsection (g) of
such section (as amended by this section); and
(ii) the total amount of all payment
adjustments for the State plan rate year (as so
increased) does not exceed the disproportionate
share hospital allotment for the State and
applicable Federal fiscal year under subsection
(f) of such section.
(B) No recoupment of payments already made to
hospitals.--A State shall not recoup any payment
adjustment made by the State to a hospital for a
Medicaid State plan rate year described in subparagraph
(A) if such payment adjustment is consistent with
section 1923(g) of such Act (42 U.S.C. 1396r-4(g)) as
in effect on October 1, 2021.
(C) Authority to permit retroactive modification of
state plan amendments to allow for increases.--
(i) In general.--Subject to paragraph (2),
solely for the purpose of allowing a State to
increase the amount of a payment adjustment to
a hospital for a Medicaid State plan rate year
described in subparagraph (A) pursuant to this
paragraph, a State may retroactively modify a
provision of the Medicaid State plan, a waiver
of such plan, or a State plan amendment that
relates to such rate year and the Secretary may
approve such modification.
(ii) Deadline.--A State may not submit a
request for approval of a retroactive
modification to a provision of the Medicaid
State plan, a waiver of such plan, or a State
plan amendment for a Medicaid State plan rate
year after the date by which the State is
required to submit the independent certified
audit for that State plan rate year as required
under section 1923(j)(2) of the Social Security
Act (42 U.S.C. 1396r-4(j)(2)).
(D) Reporting.--If a State increases a payment
adjustment made to a hospital for a Medicaid State plan
rate year pursuant to this paragraph, the State shall
include information on such increased payment
adjustment as part of the next annual report submitted
by the State under section 1923(j)(1) of the Social
Security Act (42 U.S.C. 1396r-4(j)(1)).
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