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Medicaid RAC Improvement Act of 2026
Introduced Jun 24, 2026 · Last action Jun 24, 2026 — Referred to the House Committee on Energy and Commerce.
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Summary
This legislation is called the Medicaid RAC Improvement Act of 2026. Referred to the House Committee on Energy and Commerce.
Full bill text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9422 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 9422
To implement recommendations of the Comptroller General of the United
States for improving the Medicaid Recovery Audit Contractor program and
identifying additional opportunities to recover Medicaid overpayments,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 24, 2026
Mr. Bilirakis (for himself, Mr. Arrington, Mrs. Cammack, Mr. Carter of
Georgia, Mrs. Miller-Meeks, Mr. Palmer, Mr. Bean of Florida, and Mr.
Allen) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To implement recommendations of the Comptroller General of the United
States for improving the Medicaid Recovery Audit Contractor program and
identifying additional opportunities to recover Medicaid overpayments,
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 ``Medicaid RAC Improvement Act of
2026''.
SEC. 2. IMPROVING CMS OVERSIGHT AND COMMUNICATION.
(a) Improved Oversight.--Section 1903 of the Social Security Act
(42 U.S.C. 1396b) is amended by adding at the end the following new
subsection:
``(cc) Improving State Payment Integrity.--
``(1) Definitions.--In this subsection:
``(A) Medicaid rac program.--The term `Medicaid RAC
program' means a program described in section
1902(a)(42)(B)(i).
``(B) RAC exception spa.--The term `RAC exception
SPA' means a State plan amendment submitted to the
Secretary by a State for approval of a full exception
from, or an exception to 1 or more of, the requirements
described in section 1902(a)(42)(B).
``(2) Improved oversight of medicaid rac program
exceptions.--Not later than 180 days after the date of
enactment of this subsection, the Secretary shall establish and
implement policies and procedures for the following:
``(A) Communicate expiration of medicaid rac
program exception.--Clearly communicating to a State
with an approved RAC exception SPA--
``(i) the expiration date of the approval;
and
``(ii) a statement that the RAC exception
SPA approval expiration date shall not be
extended after 2029.
``(B) Monitoring of rac exception spa
expirations.--Monitoring of RAC exception SPA
expiration dates and notifying States with respect to
any upcoming expiration date.
``(C) State reports.--Requiring annual, detailed
reporting from a State with an approved RAC exception
SPA that includes an overview of the State's Medicaid
RAC program, including methodologies and justifications
for audit limits or exclusions applied under the
program.
``(3) Improved reporting to congress on the effectiveness
of the medicaid rac program.--
``(A) In general.--Not later than December 31,
2027, and annually thereafter, the Secretary, in
collaboration with State Medicaid agencies, shall
submit to Congress a report describing the
effectiveness of the Medicaid RAC program for the most
recently ended fiscal year.
``(B) Contents.--Each report submitted by the
Secretary to Congress under subparagraph (A) shall
include the following information with respect to the
reporting period:
``(i) State-specific information.--For each
State:
``(I) A summary of the State's
Medicaid RAC program, including
methodologies and justifications for
audit limits or exclusions applied
under the program, and a description of
any approved exceptions.
``(II) The aggregate amount of
Medicaid overpayments recovered and the
amount of each overpayment recovered.
``(III) The aggregate amount of
Medicaid underpayments and the amount
(actual or estimated) of each
underpayment.
``(IV) If the State that has
implemented pre-payment review of
Medicaid payments to beneficiaries, the
aggregate amount of savings (actual or
estimated) attributable to such pre-
payment review.
``(V) The percentage of appeals of
demands for overpayment that ended in
settlement and, with respect to any
such settlement amount, the percentage
of such amount in comparison to the
original overpayment demanded.
``(VI) The 5 initiatives most often
implemented by the State to reduce
overpayments and underpayments.
``(VII) The number of audit
categories--
``(aa) conducted by a
State; or
``(bb) on hold or denied by
a State.
``(ii) Secretary recommendations.--
Recommendations for expanding or improving the
Medicaid RAC program, as the Secretary
determines appropriate.''.
(b) Conforming Amendment.--Section 1902(a)(42)(B)(i) of the Social
Security Act (42 U.S.C. 1396a(a)(42)(B)(i)) is amended by inserting
``(but only through December 31, 2028)'' after ``exceptions''.
SEC. 3. REQUIRING MEDICAID MANAGED CARE PLANS TO BE INCLUDED IN
MEDICAID RAC PROGRAMS.
Section 1902(a)(42) of the Social Security Act (42 U.S.C.
1396a(a)(42)) is amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) in subparagraph (B)(ii)--
(A) in subclause (III), by striking ``and'' at the
end; and
(B) by adding at the end the following new
subclause:
``(V) such program is carried out
in a robust manner likely to identify
and recoup or prevent a substantial
portion of overpayments and
specifically includes a review of
claims paid by medicaid managed care
organizations (as defined in section
1903(m)(1)(A)), prepaid inpatient
health plans (as defined in section
1903(m)(9)(D)(iii)(I)), and prepaid
ambulatory health plans (as defined in
section 1903(m)(9)(D)(iii)(II));''; and
(3) by adding at the end the following new subparagraph:
``(C) not later than January 1, 2028, the State
shall provide assurances satisfactory to the Secretary
that the State has an adequate process for ensuring
that any contract with a medicaid managed care
organization (as defined in section 1903(m)(1)(A)),
prepaid inpatient health plan (as defined in section
1903(m)(9)(D)(iii)(I)), or prepaid ambulatory health
plan (as defined in section 1903(m)(9)(D)(iii)(II)),
and a State shall include provisions under which such
an organization or health plan--
``(i) shall either--
``(I) elect to engage in a period
of payment integrity review by
designating a period (not to exceed the
lesser of 18 months after payment for a
claim or the term of the contract with
the managed care organization) during
which the organization or health plan
shall be permitted to engage in efforts
to identify underpayments and
overpayments and recoup overpayments
under the State plan and under any
waiver of the State plan with respect
to all services for which payment is
made to the organization or health plan
under such plan or waiver; or
``(II) agree to permit a Medicaid
recovery audit contractor (as described
in subparagraph (B)) engaged by the
State to engage in such payment
integrity review; and
``(ii) shall agree to--
``(I) cooperate with any Medicaid
recovery audit contractor (as so
described) engaged by the State to
identify any such underpayments and
overpayments and recoup any
overpayments under the State plan and
under any waiver of the State plan
(after the expiration of the period
designated under clause (i)(I), if the
organization or health plan has elected
such a period); and
``(II) coordinate such recovery
audit efforts in the same manner
described in subparagraph
(B)(ii)(IV)(cc); and''.
SEC. 4. ADDITIONAL MEASURES FOR IMPROVING MEDICAID PAYMENT INTEGRITY.
(a) Annual Reports Regarding State Payment Integrity Reviews.--
Section 1903(cc) of the Social Security Act (42 U.S.C. 1396b), as added
by section 2(a) of this Act, is amended by adding at the end the
following new paragraph:
``(4) Annual reports regarding state payment integrity
reviews.--
``(A) State reports.--Not later than 1 year after
the date of enactment of this paragraph, and annually
thereafter, each State shall submit, separate from the
information reported under paragraph (2)(C), a report
to the Secretary, in such standard form and manner as
the Secretary shall specify, that identifies the
reviewing entity (including any recovery audit
contractor or other program integrity entity) for each
payment stream (including a non-State funded payment
and capitation or other payments made to a medicaid
managed care organization (as defined in section
1903(m)(1)(A)), prepaid inpatient health plan (as
defined in section 1903(m)(9)(D)(iii)(I)), or prepaid
ambulatory health plan (as defined in section
1903(m)(9)(D)(iii)(II))) under the State plan or under
a waiver of such State plan with respect to all items
and services for which payment is made for the
applicable reporting period.
``(B) Reports to congress.--Not later than 180 days
after the date of each annual State reporting deadline
under subparagraph (A), the Secretary shall prepare and
submit to Congress a report detailing the information
contained in such State reports, together with
recommendations for such legislation and administrative
action as the Secretary determines appropriate.''.
(b) Identifying and Testing Barriers to State Participation in
Medicaid RAC Programs.--Section 1903(cc) of the Social Security Act, as
amended by subsection (a), is amended by adding at the end the
following new paragraphs:
``(5) Study on barriers to state participation in medicaid
rac programs.--
``(A) In general.--The Secretary shall conduct a
study on barriers to State establishment and
implementation of Medicaid RAC programs as required
under section 1902(a)(42)(B)(i). Such study shall
examine--
``(i) the contingency fee payment structure
for recovery audit contractors, including--
``(I) whether such payment
structure ensures a healthy and
competitive marketplace for States to
establish and implement Medicaid RAC
programs; and
``(II) the effectiveness of such
payment structure based on the
population of a State that participates
in the State Medicaid program;
``(ii) alternative arrangements for
engaging recovery audit contractors, including
the viability of multi-State contracts; and
``(iii) the start up costs associated with
establishing a new Medicaid RAC program in a
State, including--
``(I) the amount of time before a
recovery audit contractor starts
recouping overpayments to the extent
that the recovery audit contractor
recovers such start up costs; and
``(II) recommendations for a
payment structure that could include
initial funding to a recovery audit
contractor.
``(B) Report.--Not later than 1 year after the date
of enactment of this paragraph, the Secretary shall
submit to Congress a report containing the results of
the study conducted under subparagraph (A), together
with recommendations for such legislation and
administrative action as the Secretary determines
appropriate.
``(6) Demonstration project to improve state participation
in medicaid rac programs.--
``(A) In general.--Not later than 2 years after the
date of enactment of this paragraph, based on the study
conducted under paragraph (5), the Secretary shall
conduct a 5-year demonstration project designed to
increase the number of States that establish and
implement a Medicaid RAC program in accordance with
section 1902(a)(42)(B)(i).
``(B) Reports to congress.--The Secretary shall
submit an interim report to Congress on the
demonstration project conducted under this paragraph
not later than 90 days after the initiation of the
demonstration project, and a final report not later
than 180 days after the demonstration project ends. The
final report shall include an evaluation of the project
and recommendations for such legislation and
administrative action as the Secretary determines
appropriate.''.
(c) Audit and Recovery Periods.--Section 1902(a)(42) of the Social
Security Act (42 U.S.C. 1396a(a)(42)), as amended by section 3, is
amended by adding at the end the following new subparagraph:
``(D) notwithstanding clause (i) of subparagraph
(B), beginning 120 days after the date of enactment of
this subparagraph, each contract entered into by the
State with a recovery audit contractor under the
program described in subparagraph (B), including any
contract with a recovery audit contractor applying to a
medicaid managed care organization (as defined in
section 1903(m)(1)(A)), prepaid inpatient health plan
(as defined in section 1903(m)(9)(D)(iii)(I)), or
prepaid ambulatory health plan (as defined in section
1903(m)(9)(D)(iii)(II)), shall provide that audit and
recovery activities shall be conducted during a fiscal
year with respect to payments made under the State plan
and under any waiver of the State plan, or, if
applicable, payments made by such an organization or
health plan, during such fiscal year and
retrospectively for a period of 4 fiscal years prior to
such fiscal year;''.
<all>Official legislative text sourced from the public record (cached on CivicsHQ).
Official source
View the original bill, actions, and full legislative record on Congress.gov.
Status
In Committee
- 1Introduced
- 2Committee
- 3Floor
- 4Passed
- 5Signed
Timeline reflects current normalized status only. Full action history is not yet stored in the API.
Sponsors
- Rep. Bilirakis, Gus M. [R-FL-12]RHouseFL
Votes
Voting records are not yet available for this bill.