HouseH.R. 10640119th Congress
Urban Health Transformation Act of 2026
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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10640 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 10640
To amend title XI of the Social Security Act to establish an Urban
Health Transformation Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 1, 2026
Ms. Waters (for herself, Mr. Bell, Mr. Carson, Ms. Clarke of New York,
Mr. Correa, Mr. Costa, Mr. Davis of Illinois, Ms. Garcia of Texas, Mr.
Jackson of Illinois, Ms. Kelly of Illinois, Mr. Lynch, Ms. Norton, and
Mrs. Ramirez) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XI of the Social Security Act to establish an Urban
Health Transformation 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 ``Urban Health Transformation Act of
2026''.
SEC. 2. URBAN HEALTH TRANSFORMATION PROGRAM.
(a) In General.--Part A of title XI of the Social Security Act (42
U.S.C. 1301 et seq.) is amended by inserting after section 1150C the
following new section:
``SEC. 1150D. URBAN HEALTH TRANSFORMATION PROGRAM.
``(a) Appropriation.--
``(1) In general.--There are appropriated, out of any money
in the Treasury not otherwise appropriated, to the
Administrator of the Centers for Medicare & Medicaid Services
(in this section referred to as the `Administrator'), to
provide allotments to States for purposes of carrying out the
activities described in subsection (f)--
``(A) $10,000,000,000 for fiscal year 2027;
``(B) $10,000,000,000 for fiscal year 2028;
``(C) $10,000,000,000 for fiscal year 2029;
``(D) $10,000,000,000 for fiscal year 2030; and
``(E) $10,000,000,000 for fiscal year 2031.
``(2) Unexpended or unobligated funds.--
``(A) In general.--Any amounts appropriated under
paragraph (1) that are unexpended or unobligated as of
October 1, 2033, shall be returned to the Treasury of
the United States.
``(B) Redistribution of unexpended or unobligated
funds.--In carrying out paragraph (1), the
Administrator shall, not later than March 31, 2029, and
annually thereafter through March 31, 2033, determine
the amount of funds, if any, that are available under
such paragraph for a previous fiscal year, are
unexpended or unobligated with respect to such fiscal
year, and will not be available to a State in the
current fiscal year, pursuant to subparagraph (C).
``(C) Availability of funds.--
``(i) In general.--Amounts allotted to a
State under this section for a year shall be
available for expenditure by the State through
the end of the fiscal year following the fiscal
year in which such amounts are allotted.
``(ii) Availability of amounts
redistributed.--Amounts redistributed to a
State under subparagraph (B) with respect to a
fiscal year shall be available for expenditure
by the State through the end of the fiscal year
following the fiscal year in which such amounts
are redistributed (except in the case of
amounts redistributed in fiscal year 2033 which
shall only be available for expenditure through
September 30, 2033).
``(D) Misuse of funds.--If the Administrator
determines that a State is not using amounts allotted
or redistributed to the State under this section in a
manner consistent with the description provided by the
State in its application approved under subsection (b),
the Administrator may withhold payments to, or reduce
payments to, or recover previous payments from, the
State under this section as the Administrator deems
appropriate, and any amounts so withheld, or that
remain after any such reduction, or so recovered, shall
be returned to the Treasury of the United States.
``(b) Application.--
``(1) In general.--To be eligible for an allotment under
this section, a State shall submit to the Administrator during
an application submission period to be specified by the
Administrator (but that ends not later than December 31, 2026)
an application in such form and manner as the Administrator may
specify, that includes--
``(A) a detailed urban health transformation plan--
``(i) to improve access to hospitals, other
health care providers, and health care items
and services furnished to urban residents of
the State;
``(ii) to improve health care outcomes of
urban residents of the State;
``(iii) to prioritize the use of new and
emerging technologies that emphasize prevention
and chronic disease management;
``(iv) to initiate, foster, and strengthen
local and regional strategic partnerships
between urban hospitals and other health care
providers in order to promote measurable
quality improvement, increase financial
stability, maximize economies of scale, and
share best practices in care delivery;
``(v) to enhance economic opportunity for,
and the supply of, health care clinicians
through enhanced recruitment and training;
``(vi) to prioritize data and technology
driven solutions that help urban hospitals and
other urban health care providers furnish high-
quality health care services as close to a
patient's home as is possible;
``(vii) that outlines strategies to manage
long-term financial solvency and operating
models of urban hospitals in the State; and
``(viii) that identifies specific causes
driving the accelerating rate of stand-alone
urban hospitals becoming at risk of closure,
conversion, or service reduction;
``(B) a certification that none of the amounts
provided under this section shall be used by the State
for an expenditure that is attributable to an
intergovernmental transfer, certified public
expenditure, or any other expenditure to finance the
non-Federal share of expenditures required under any
provision of law, including under the State plan
established under title XIX, the State plan established
under title XXI, or under a waiver of such plans; and
``(C) such other information as the Administrator
may require.
``(2) Deadline for approval.--Not later than December 31,
2026, the Administrator shall approve or deny all applications
submitted for an allotment under this section.
``(3) One-time application.--If an application of a State
for an allotment under this section is approved by the
Administrator, the State shall be eligible for an allotment
under this section for each of fiscal years 2027 through 2031,
except as provided in subsection (a)(2)(D).
``(4) Eligibility.--The 50 States, the District of
Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern
Mariana Islands, and American Samoa shall be eligible for an
allotment under this section and all references in this section
to a State shall be treated as referring to the 50 States, the
District of Columbia, Puerto Rico, the Virgin Islands, Guam,
the Northern Mariana Islands, and American Samoa.
``(c) Allotments.--
``(1) In general.--For each of fiscal years 2027 through
2031, the Administrator shall determine under paragraph (2) the
amount of the allotment for such fiscal year for each State
with an approved application under this section.
``(2) Amount determined.--Subject to paragraph (3), from
the amounts appropriated under subsection (a)(1) for each of
fiscal years 2027 through 2031, the Administrator shall allot--
``(A) 50 percent of the amounts appropriated for
each such fiscal year equally among all States with an
approved application under this section; and
``(B) 50 percent of the amounts appropriated for
each such fiscal year among all such States in an
amount to be determined by the Administrator in
accordance with paragraph (3).
``(3) Requirements.--In determining the amount to be
allotted to a State under subparagraph (B) of paragraph (2) for
a fiscal year, the Administrator shall--
``(A) ensure that not less than \1/4\ of the States
with an approved application under this section for a
fiscal year are allotted funds from amounts that are to
be allotted under subparagraph (B) of such paragraph;
and
``(B) consider--
``(i) the percentage of the State
population that is located in an urban area;
``(ii) the proportion of urban health
facilities (as defined in paragraph (4)) in the
State relative to the number of urban health
facilities nationwide; and
``(iii) any other factors that the
Administrator determines appropriate.
``(4) Urban health facility defined.--For the purposes of
paragraph (3)(B), the term `urban health facility' means the
following:
``(A) A facility defined as a disproportionate
share hospital under section 1923(a)(1)(A).
``(B) A hospital with an approved medical residency
training program (as defined in section 1886(h)(5)(A)).
``(C) A subsection (d) hospital (as defined in
section 1886(d)(1)(B)) that is in the 75th percentile
with respect to inpatient hospital services furnished
to--
``(i) individuals dually eligible under
titles XVIII and XIX; or
``(ii) subsidy eligible individuals (as
defined in section 1860D-14(a)(3)).
``(D) A hospital that is located in an urban area
and, based upon the determination of the State, serves
a large number of residents who are low-income,
uninsured, or receiving medical assistance under a
State plan (or a waiver of such plan) under title XIX.
``(E) A Federally qualified health center (as
defined in section 1861(aa)(4)).
``(F) A community mental health center (as defined
in section 1861(ff)(3)(B)).
``(G) A health center that is receiving a grant
under section 330 of the Public Health Service Act.
``(H) An opioid treatment program (as defined in
section 1861(jjj)(2)) that is located in an urban area.
``(I) A substance use disorder treatment program
that is located in an urban area.
``(J) A certified community behavioral health
clinic (as defined in section 1905(jj)(2)) that is
located in an urban area.
``(d) No Matching Payment.--A State approved for an allotment under
this section for a fiscal year shall not be required to provide any
matching funds as a condition for receiving payments from the
allotment.
``(e) Terms and Conditions.--The Administrator shall specify such
terms and conditions for allotments to States provided under this
section as the Administrator deems appropriate, including the
following:
``(1) Each State shall submit to the Administrator (at a
time, and in a form and manner, specified by the
Administrator)--
``(A) a plan for the State to use its allotment to
carry out 3 or more of the activities described in
subsection (f); and
``(B) annual reports on the use of allotments,
including such additional information as the
Administrator determines appropriate.
``(2) Not more than 10 percent of the amount allotted to a
State for a fiscal year may be used by the State for
administrative expenses.
``(f) Use of Funds.--Amounts allotted to a State under this section
shall be used for 3 or more of the following health-related activities:
``(1) Promoting evidence-based, measurable interventions to
improve prevention and chronic disease management.
``(2) Providing payments to health care providers for the
provision of health care items or services, as specified by the
Administrator.
``(3) Promoting consumer-facing, technology-driven
solutions for the prevention and management of chronic
diseases.
``(4) Providing training and technical assistance for the
development and adoption of technology-enabled solutions that
improve care delivery in urban hospitals, including remote
monitoring, robotics, artificial intelligence, and other
advanced technologies.
``(5) Recruiting and retaining clinical workforce talent to
urban areas, with commitments to serve urban communities for a
minimum of 5 years.
``(6) Providing technical assistance, software, and
hardware for significant information technology advances
designed to improve efficiency, enhance cybersecurity
capability development, and improve patient health outcomes.
``(7) Assisting urban communities to right size their
health care delivery systems by identifying needed
preventative, ambulatory, pre-hospital, emergency, acute
inpatient care, outpatient care, and post-acute care service
lines.
``(8) Supporting access to opioid use disorder treatment
services (as defined in section 1861(jjj)(1)), other substance
use disorder treatment services, and mental health services.
``(9) Developing projects that support innovative models of
care that include value-based care arrangements and alternative
payment models, as appropriate.
``(10) Additional uses designed to promote sustainable
access to high quality urban health care services, as
determined by the Administrator.
``(g) Definitions.--In this section:
``(1) Health care provider.--The term `health care
provider' means a provider of services or supplier who is
enrolled under title XVIII, title XIX, or title XXI.
``(2) Urban area.--The term `urban area' means a
metropolitan statistical area with a population of 1,000,000 or
more.''.
(b) Implementation.--The Administrator of the Centers for Medicare
& Medicaid Services shall implement this section, including the
amendments made by this section, by program instruction or other forms
of program guidance.
(c) Implementation Funding.--For the purposes of carrying out the
provisions of, and the amendments made by, this section, there are
appropriated, out of any monies in the Treasury not otherwise
appropriated, to the Administrator of the Centers for Medicare &
Medicaid Services, $200,000,000 for fiscal year 2026, to remain
available until expended.
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