To amend title XIX of the Social Security Act to establish a definition of essential health system in statute and for other related purposes.
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Progress
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- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Overview
This bill amends the Social Security Act to establish a formal definition of "essential health system" within the context of Medicaid and Medicare. It identifies hospitals that meet specific criteria – including high volumes of care for low-income patients, uncompensated care payments, or a high percentile ranking among similar hospitals – and designates them as essential. The bill also creates an ‘essential health system index’ to rank these hospitals and directs the Medicare Payment Advisory Commission (MACPAC) to maintain a list of these systems and develop an index to assess their performance and inform payment policies.
Key provisions
- Defines ‘essential health system’ as a subsection (d) hospital meeting specific criteria related to low-income patient care.
- Establishes an ‘essential health system index’ to rank hospitals based on their performance against defined metrics.
- Requires MACPAC to maintain a list of essential health systems and publish their index values annually.
- Sets criteria for hospitals to be designated as essential, including Medicare disproportionate patient percentage, uncompensated care payment factor, and state-adjusted low-income care criteria.
- Provides for a 5-year designation period for essential health systems, subject to redesignation based on continued performance.
- Directs payment policies to consider the essential health system index when providing targeted support.
- Mandates MACPAC to report on newly designated and previously designated essential health systems.
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