119-hr5064

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5064 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 5064

 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 HOUSE OF REPRESENTATIVES

 August 29, 2025

 Mr. LaLota (for himself, Mr. Lawler, Mr. Mrvan, and Ms. Clarke of New 
 York) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce

_______________________________________________________________________

 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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