Better Care, Better Cost Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9336 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9336

To amend title XIX of the Social Security Act to require States to take
  into account performance when assigning individuals to managed care
                  entities under the Medicaid program.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             June 18, 2026

   Mr. Goldman of Texas (for himself and Mr. Pfluger) 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 States to take
  into account performance when assigning individuals to managed care
                  entities under the Medicaid program.

    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 ``Better Care, Better Cost Act''.

SEC. 2. REQUIRING STATES TO TAKE INTO ACCOUNT PERFORMANCE WHEN
              ASSIGNING INDIVIDUALS TO MANAGED CARE ENTITIES UNDER THE
              MEDICAID PROGRAM.

    (a) In General.--Section 1932(a)(4) of the Social Security Act (42
U.S.C. 1396u-2(a)(4)) is amended---
            (1) in subparagraph (D)(ii)(II), by striking ``the
        equitable'' and all that follows through the period and
        inserting ``the performance score of such entities, as
        determined under the system established by the State under
        subparagraph (E).''; and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Performance.--
                            ``(i) In general.--A State shall--
                                    ``(I) establish a system to
                                evaluate the performance of managed
                                care entities participating under the
                                State plan (or wavier of such plan) of
                                such State; and
                                    ``(II) on an annual basis, publish
                                a report--
                                            ``(aa) evaluating the
                                        differences in default
                                        enrollments made taking into
                                        account the performance scores
                                        of managed care entities under
                                        this subparagraph compared to
                                        such enrollments that would
                                        have been made had such scores
                                        not been taken into account;
                                        and
                                            ``(bb) quantifying any
                                        estimated reduction in
                                        expenditures under such plan
                                        (or waiver) attributable to
                                        taking into account such scores
                                        in default enrollments.
                            ``(ii) Score.--Under the system established
                        by a State under clause (i), the State shall
                        assign a performance score for each managed
                        care entity described in such clause based on
                        such cost and outcome measures and such
                        individual satisfaction measures as determined
                        appropriate by the State. Measures used under
                        such system may include, with respect to
                        individuals enrolled under such entity,
                        measures of the performance of such entity
                        (compared to the risk-adjusted expected
                        performance of such entity) with respect to the
                        following:
                                    ``(I) Expenditures for medical
                                assistance.
                                    ``(II) Potentially avoidable
                                hospital readmissions.
                                    ``(III) Potentially avoidable
                                emergency department visits.
                                    ``(IV) Potentially avoidable
                                hospital admissions.
                                    ``(V) Satisfaction scores from such
                                individuals and the rate at which such
                                individuals elect to terminate
                                enrollment with such entity.''.
    (b) Effective Date.--The amendments made by this section shall
apply with respect to the enrollment of individuals in managed care
entities under a State plan under title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.), or under a waiver of such plan, on or after
January 1, 2028.
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