I 

118TH CONGRESS 

2D SESSION H. R. 8113 

To amend title XIX of the Social Security Act to require reporting on 

certain directed payments under the Medicaid program. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 23, 2024 

Mr. GRIFFITH 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 require 

reporting on certain directed payments under the Medicaid program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Transparency into 

5 State Directed Payments Act of 2024’’. 

6 SEC. 2. STATE DIRECTED PAYMENT REPORTING REQUIRE7 MENTS. 

8 Section 1903 of the Social Security Act (42 U.S.C. 

9 1396b) is amended by adding at the end the following new 

10 subsection: 


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1 ‘‘(cc) STATE DIRECTED PAYMENT REPORTING RE2 QUIREMENTS.— 

3 ‘‘(1) COLLECTION AND AVAILABILITY OF DI4 RECTED PAYMENT DATA.— 

5 ‘‘(A) IN GENERAL.—Not later than Janu6 ary 1, 2026, the Secretary shall establish a sys7 tem for each State to submit a report, at inter8 vals as determined appropriate by the Sec9 retary, on directed payment data, as a require10 ment for a State plan or a State plan amend11 ment that would provide for a directed payment 

12 arrangement. 

13 ‘‘(B) REQUIREMENTS.—Each report sub14 mitted by a State in accordance with the re15 quirement established under subparagraph (A) 

16 shall include the following: 

17 ‘‘(i) An explanation of how directed 

18 payments made under the State plan or a 

19 State plan amendment will result in pay20 ments that are consistent with section 

21 1902(a)(30)(A), including standards with 

22 respect to efficiency, economy, quality of 

23 care, and access, along with the stated 

24 purpose and intended effects of the di25 rected payment. 


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1 ‘‘(ii) The criteria used to determine 

2 which providers are eligible to receive the 

3 directed payment. 

4 ‘‘(iii) A comprehensive description of 

5 the methodology used to calculate the 

6 amount of, and distribute, the directed 

7 payment to each eligible provider, includ8 ing— 

9 ‘‘(I) data on the amount of the 

10 directed payment made to each eligi11 ble provider, if known, or, if the total 

12 amount is distributed using a formula 

13 based on data from 1 or more fiscal 

14 years, data on the total amount of the 

15 directed payments for the fiscal year 

16 or years available to all providers eli17 gible to receive a directed payment; 

18 ‘‘(II) if applicable, the specific 

19 criteria with respect to Medicaid serv20 ice, utilization, or cost data to be used 

21 as the basis for calculations regarding 

22 the amount or distribution of the di23 rected payment; and 


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1 ‘‘(III) the timing of the directed 

2 payment made to each eligible pro3 vider. 

4 ‘‘(iv) An analysis of how total Med5 icaid payments made to an eligible pro6 vider, including the directed payment, com7 pare relative to the upper payment limit 

8 for such provider and the average commer9 cial rate for the services to which the pay10 ment relates. 

11 ‘‘(v) The net payment rate to a pro12 vider receiving a directed payment that is 

13 inclusive of base payment rates, supple14 mental payments (as defined in subsection 

15 (bb)), and any such directed payments. 

16 ‘‘(C) PUBLIC AVAILABILITY.—The Sec17 retary shall make all reports and related data 

18 submitted under this paragraph publicly avail19 able on the website of the Centers for Medicare 

20 & Medicaid Services on a timely basis. 

21 ‘‘(2) DEFINITIONS.—In this subsection: 

22 ‘‘(A) DIRECTED PAYMENT ARRANGE23 MENT.—The term ‘directed payment arrange24 ment’ means a contract arrangement between a 

25 State and a managed care organization, prepaid 


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1 ambulatory health plan, or prepaid inpatient 

2 health plan that directs the expenditures of 

3 such managed care organization, prepaid ambu4 latory health plan, or prepaid inpatient health 

5 plan in a manner allowable under section 438.6 

6 of title 42, Code of Federal Regulations (or any 

7 successor regulation). 

8 ‘‘(B) DIRECTED PAYMENT.—The term ‘di9 rected payment’ means a payment to a provider 

10 made pursuant to a directed payment arrange11 ment. 

12 ‘‘(C) PREPAID AMBULATORY HEALTH

13 PLAN; PREPAID INPATIENT HEALTH PLAN.— 

14 The terms ‘prepaid ambulatory health plan’ and 

15 ‘prepaid inpatient health plan’ have the mean16 ing given each such term in section 438.2 of 

17 title 42, Code of Federal Regulations (or any 

18 successor regulation).’’. 

Æ 


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