HouseH.R. 10729119th Congress
Long-Term Rural Health Investment Act of 2026
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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10729 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 10729
To amend Public Law 119-21 to adjust limitations on State directed
payments under the Medicaid program, and to repeal certain provisions
related to provider taxes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 5, 2026
Ms. Davids of Kansas introduced the following bill; which was referred
to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend Public Law 119-21 to adjust limitations on State directed
payments under the Medicaid program, and to repeal certain provisions
related to provider taxes.
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 ``Long-Term Rural Health Investment
Act of 2026''.
SEC. 2. ADJUSTING LIMITATIONS ON STATE DIRECTED PAYMENTS.
(a) In General.--Section 71116 of Public Law 119-21 is amended--
(1) by amending subsection (a) to read as follows:
``(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the Secretary) shall revise section
438.6(c)(2)(iii) of title 42, Code of Federal Regulations (or a
successor regulation), such that, with respect to a payment described
in such subsection made for a service furnished during a rating period
beginning on or after January 1, 2030, the total payment rate for such
service is limited to 200 percent of the specified total published
Medicare payment rate (or, in the absence of a specified total
published Medicare payment rate, the average commercial rate in the
State).'';
(2) by amending subsection (b) to read as follows:
``(b) Grandfathering Certain Payments.--In the case of a payment
described in section 438.6(c)(2)(iii) of title 42, Code of Federal
Regulations (or a successor regulation), for which written prior
approval (or a good faith effort to receive such approval, as
determined by the Secretary) was made before July 1, 2028, for the
first rating period occurring after July 1, 2028, or a payment so
described for such rating period for which a completed preprint was
submitted to the Secretary prior to the date of enactment of the Long-
Term Rural Health Investment Act of 2026, beginning with the rating
period on or after January 1, 2030, the total amount of such payment
shall be reduced by 10 percent of the amount of any such payment made
during the preceding rating period, each year until the total payment
rate for such service is equal to the rate for such service specified
in subsection (a).'';
(3) by striking subsection (c);
(4) in subsection (d)--
(A) by striking paragraph (2);
(B) by redesignating paragraphs (3) through (5) as
paragraphs (2) through (4), respectively; and
(C) by adding at the end the following new
paragraphs:
``(5) Final capitation rate.--The term `final capitation
rate' has the meaning given such term in section 438.3(c) of
title 42, Code of Federal Regulations (or a successor
regulation).
``(6) Medicaid managed care organization.--The term
`medicaid managed care organization' has the meaning given such
term in section 1903(m)(1)(A) of the Social Security Act (42
U.S.C. 1396b(m)(1)(A)).
``(7) Prepaid inpatient health plan.--The term `prepaid
inpatient health plan' has the meaning given such term in
section 438.2 of title 42, Code of Federal Regulations (or a
successor regulation).
``(8) Prepaid ambulatory health plan.--The term `prepaid
ambulatory health plan' has the meaning given such term in
section 438.2 of title 42, Code of Federal Regulations (or a
successor regulation).''; and
(5) by inserting after subsection (b) the following new
subsection:
``(c) Historical Utilization and Separate Payment Rates.--The
Secretary shall--
``(1) revise section 438.6(c)(2)(vii)(B) of title 42, Code
of Federal Regulations (or a successor regulation), such that,
with respect to a payment described in section 438.6(c)(2)(iii)
of title 42, Code of Federal Regulations (or a successor
regulation), made for services furnished during a rating period
beginning on or after January 1, 2028, a State may condition
such payment on the utilization and delivery of services
outside of the rating period for which the State is seeking
written prior approval and require that such payments be
reconciled to utilization during such rating period; and
``(2) revise section 438.6(c)(6) of title 42, Code of
Federal Regulations (or a successor regulation), such that,
with respect to a payment described in section 438.6(c)(2)(iii)
of title 42, Code of Federal Regulations (or a successor
regulation), made for services furnished during a rating period
beginning on or after January 1, 2028, a State may withhold a
portion of the final capitation rate to pay a medicaid managed
care organization, prepaid inpatient health plan, or prepaid
ambulatory health plan separately for such payment and may
require such an organization or plan to retain a portion of the
final capitation rate separately to comply with such
payment.''.
(b) 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 state directed payment
data.--
``(A) In general.--Beginning January 1, 2027, each
State shall, not later than 1 year after the end of
each rating period, submit to the Secretary through the
Transformed Medicaid Statistical Information System (T-
MSIS) (or a successor system) the data described in
subparagraph (B), as a requirement for a State plan or
State plan amendment that would provide for a State
directed payment.
``(B) Data described.--For purposes of subparagraph
(A), the data described in this subparagraph is the
following:
``(i) The total amount (in dollars)
expended by a managed care organization,
prepaid inpatient health plan, or prepaid
ambulatory health plan for State directed
payments during such rating period.
``(ii) Identifiers, as specified by the
Secretary, for enrollees, providers, managed
care organizations, prepaid inpatient health
plans, and prepaid ambulatory health plans.
``(iii) Amounts paid to individual
providers under a State directed payment.
``(iv) Amounts collected by the State to
fund the non-Federal share of State directed
payments, disaggregated by provider type.
``(v) Procedure and diagnosis codes for any
item or service for which a State directed
payment was made.
``(vi) Amounts allowed, billed, and paid
(including the amount that represents the
payment amount negotiated by the relevant
managed care organization, prepaid inpatient
health plan, or prepaid ambulatory health plan,
the amount of the State directed payment, and
any other amounts included in the total amount
paid to the provider) in connection with an
item or service for which a State directed
payment was made.
``(2) Definitions.--In this subsection:
``(A) Medicaid managed care organization.--The term
`medicaid managed care organization' has the meaning
given such term in section 1903(m)(1)(A).
``(B) Prepaid inpatient health plan.--The term
`prepaid inpatient health plan' has the meaning given
such term in section 438.2 of title 42, Code of Federal
Regulations (or a successor regulation).
``(C) Prepaid ambulatory health plan.--The term
`prepaid ambulatory health plan' has the meaning given
such term in section 438.2 of title 42, Code of Federal
Regulations (or a successor regulation).
``(D) Rating period.--The term `rating period' has
the meaning given such term in section 438.2 of title
42, Code of Federal Regulations (or a successor
regulation).
``(E) State directed payment.--The term `State
directed payment' means a payment described in section
438.6(c)(2)(iii) of title 42, Code of Federal
Regulations (or a successor regulation).''.
(c) Reverting Regulations.--For the period beginning on the date of
enactment of this section and ending on January 1, 2030, the Secretary
shall apply section 438.6(c)(2)(iii) of title 42, Code of Federal
Regulations, as such section was in effect on the day before the date
of enactment of Public Law 119-21.
SEC. 3. REPEAL OF PROVISIONS OF PUBLIC LAW 119-21 RELATED TO PROVIDER
TAXES.
(a) Repeal.--Sections 71115 and 71117 of Public Law 119-21 are
repealed and section 1903(w) of the Social Security Act (42 U.S.C.
1396b(w)) shall be applied as if such sections had not been enacted.
(b) Rescission.--The amounts appropriated under section 71115(c) of
Public Law 119-21 are hereby rescinded.
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