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 Med-
icaid program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Transparency into 
State Directed Payments Act of 2024’’. 
SEC. 2. STATE DIRECTED PAYMENT REPORTING REQUIRE-
MENTS. 
Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended by adding at the end the following new 
subsection: 
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‘‘(cc) STATE DIRECTED PAYMENT REPORTING RE-
QUIREMENTS.— 
‘‘(1) COLLECTION
AND
AVAILABILITY
OF
DI-
RECTED PAYMENT DATA.— 
‘‘(A) IN GENERAL.—Not later than Janu-
ary 1, 2026, the Secretary shall establish a sys-
tem for each State to submit a report, at inter-
vals as determined appropriate by the Sec-
retary, on directed payment data, as a require-
ment for a State plan or a State plan amend-
ment that would provide for a directed payment 
arrangement. 
‘‘(B) REQUIREMENTS.—Each report sub-
mitted by a State in accordance with the re-
quirement established under subparagraph (A) 
shall include the following: 
‘‘(i) An explanation of how directed 
payments made under the State plan or a 
State plan amendment will result in pay-
ments that are consistent with section 
1902(a)(30)(A), including standards with 
respect to efficiency, economy, quality of 
care, and access, along with the stated 
purpose and intended effects of the di-
rected payment. 
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‘‘(ii) The criteria used to determine 
which providers are eligible to receive the 
directed payment. 
‘‘(iii) A comprehensive description of 
the methodology used to calculate the 
amount of, and distribute, the directed 
payment to each eligible provider, includ-
ing— 
‘‘(I) data on the amount of the 
directed payment made to each eligi-
ble provider, if known, or, if the total 
amount is distributed using a formula 
based on data from 1 or more fiscal 
years, data on the total amount of the 
directed payments for the fiscal year 
or years available to all providers eli-
gible to receive a directed payment; 
‘‘(II) if applicable, the specific 
criteria with respect to Medicaid serv-
ice, utilization, or cost data to be used 
as the basis for calculations regarding 
the amount or distribution of the di-
rected payment; and 
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‘‘(III) the timing of the directed 
payment made to each eligible pro-
vider. 
‘‘(iv) An analysis of how total Med-
icaid payments made to an eligible pro-
vider, including the directed payment, com-
pare relative to the upper payment limit 
for such provider and the average commer-
cial rate for the services to which the pay-
ment relates. 
‘‘(v) The net payment rate to a pro-
vider receiving a directed payment that is 
inclusive of base payment rates, supple-
mental payments (as defined in subsection 
(bb)), and any such directed payments. 
‘‘(C) PUBLIC
AVAILABILITY.—The Sec-
retary shall make all reports and related data 
submitted under this paragraph publicly avail-
able on the website of the Centers for Medicare 
& Medicaid Services on a timely basis. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) 
DIRECTED
PAYMENT
ARRANGE-
MENT.—The term ‘directed payment arrange-
ment’ means a contract arrangement between a 
State and a managed care organization, prepaid 
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ambulatory health plan, or prepaid inpatient 
health plan that directs the expenditures of 
such managed care organization, prepaid ambu-
latory health plan, or prepaid inpatient health 
plan in a manner allowable under section 438.6 
of title 42, Code of Federal Regulations (or any 
successor regulation). 
‘‘(B) DIRECTED PAYMENT.—The term ‘di-
rected payment’ means a payment to a provider 
made pursuant to a directed payment arrange-
ment. 
‘‘(C) 
PREPAID
AMBULATORY
HEALTH 
PLAN; PREPAID
INPATIENT
HEALTH
PLAN.— 
The terms ‘prepaid ambulatory health plan’ and 
‘prepaid inpatient health plan’ have the mean-
ing given each such term in section 438.2 of 
title 42, Code of Federal Regulations (or any 
successor regulation).’’. 
Æ 
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